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Duokopf- versus Totalendoprothese zur Versorgung von Schenkelhalsfrakturen

Ist die Hemiendoprothese eine halbe Sache?

Hemiarthroplasty vs. total hip arthroplasty in the treatment of femoral neck fractures

Is hemiarthroplasty only a half measure?

  • Leitthema
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Trauma und Berufskrankheit

Zusammenfassung

Hintergrund

In Deutschland ist die Therapie der Wahl der dislozierten medialen Schenkelhalsfraktur des älteren Menschen die endoprothetische Versorgung innerhalb von 24 h. Als operative Optionen stehen sich die Hüfttotalendoprothese (HTEP) und die Hemiendoprothese (HE) gegenüber.

Fragestellung

Es wird folgenden Fragen nachgegangen: differenzierte Patientenselektion für HTEP oder HE, „Ist die HE eine halbe Sache?“, zementierte oder zementfreie (Schaft‑)Implantation, geänderte Vorgehensweise durch neue, operative Zugänge.

Material und Methode

Es erfolgte eine Analyse der nationalen Prothesenregister sowie des Endoprothesenregister Deutschlands (EPRD) mit Darstellung der Versorgungshäufigkeit der medialen Schenkelhalsfraktur mit der endoprothetischen Versorgung durch HE vs. HTEP.

Ergebnisse

Die Durchsicht der nationalen Register zeigt eine Favorisierung der zementierten Technik bei älteren Patienten und bestätigt die niedrigeren Luxations- und Revisionsraten für die HE im Vergleich zur HTEP. Aus den Daten des EPRD zeigt sich, dass 2017 insgesamt 9,5 % der hüftendoprothetischen Eingriffe mit HEs durchgeführt wurden. Es ergab sich eine höhere Revisionsrate für nichtelektive HTEPs von 7,0 % im Vergleich zu HEs mit 4,5 %.

Schlussfolgerungen

Die Auswahl des Implantats für die endoprothetische Versorgung nach medialer Schenkelhalsfraktur ist abhängig von einer Vielzahl von patienten-, operateur- und implantatspezifischen Faktoren. Die geringeren Revisionsraten der HE widerlegen die Annahme, dass eine HE nur „eine halbe Sache“ sei. Anteriore oder anterolaterale Zugänge sind dem posterioren Zugang hinsichtlich Luxationstendenz überlegen. Nationale Unterschiede zeigen sich in Bezug auf die Zementierung der Prothese.

Abstract

Background

In Germany the treatment of choice for dislocated medial femoral neck fractures in older patients is arthroplasty of the hip within 24 h. Operative options include total hip arthroplasty (THA) and hemiarthroplasty (HA).

Objective

Differentiated patient selection for THA or HA, is HA only a half measure, cemented or cementless (stem) implantation, altered approach due to new surgical access routes?

Material and methods

Analysis of the national prosthesis registers worldwide and the German Arthroplasty Register (EPRD) with presentation of the rates of arthroplasty options THA vs. HA for dislocated medial femoral neck fractures.

Results

The review of the national registries showed that a cemented technique was favored in older patients and confirmed the lower revision rate for HA. The data from the EPRD showed that in 2017 a total of 9.5% of all hip arthroplasty surgeries were performed with HA. There was a higher revision rate for patients undergoing non-elective THA (7.0%) compared to HA (4.5%).

Conclusion

The choice of implant in hip arthroplasty for medial femoral neck fractures depends on a variety of patient, surgeon and implant-specific factors. The significantly lower revision rate of the HA disproves the assumption that HA is “only a half measure”. Anterior or lateral approaches seem to be superior compared to posterior approaches, particularly with respect to the dislocation rate. National differences are evident in cementation of the prosthesis.

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Correspondence to Sven Hungerer M.D..

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S. Hungerer, C. Glowalla, M. Berninger und F. Stuby geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Hungerer, S., Glowalla, C., Berninger, M. et al. Duokopf- versus Totalendoprothese zur Versorgung von Schenkelhalsfrakturen. Trauma Berufskrankh 21, 31–38 (2019). https://doi.org/10.1007/s10039-019-0421-3

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