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Revisionsendoprothetik

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AE-Manual der Endoprothetik

Zusammenfassung

Wichtig vor jeder Revision ist die Klärung der Ursache für die angegebenen Beschwerden. Unklare Schmerzen bei liegender Hüftendoprothese stellen an sich noch keine Indikation zu einer Wechseloperation dar. Es muss herausgefunden werden, ob die Ursache der Schmerzen mit dem Implantat in Zusammenhang gebracht werden kann. Mögliche Ursachen sind neben einer aseptischen Lockerung unter anderem der periprothetische Infekt, die Reizung der Psoassehne durch eine zu stark antevertiert stehende Pfanne, Impingement-Probleme durch z. B. ein zu geringes Offset mit Anschlagen des Trochanters an den Beckenknochen oder allergische Reaktionen auf Implantatkomponenten. Nicht mit dem Implantat assoziierte Beschwerdeursachen müssen ausgeschlossen werden. Vor allem sind vertebragen bedingte Schmerzen mit Ausstrahlung in Oberschenkel und Leiste durch entsprechende klinische und bei Verdacht bildgebende Diagnostik auszuschließen. Eine weitere Ursache für hüftnahe Beschwerden kann eine Ruptur des Musculus gluteus medius an der Insertionsstelle des Trochanter major sein. Diese kann durch eine degenerative Insertionstendopathie entstehen oder iatrogen nach einem transglutealen Zugang mit mangelnder Einheilung der Muskelreinsertion verursacht sein. Bei ersterem Grund finden sich häufig im Röntgenbild enthesiopathische Ausziehungen am Trochanter major. Klinisch fällt eine Schwäche der Glutealmuskulatur mit positivem Trendelenburg-Zeichen sowie abgeschwächter Abduktion und Innenrotation auf. Die Diagnose wird durch eine Kernspintomographie erhärtet, in der neben der Ruptur häufig eine Bursitis trochanterica zu sehen ist. Die Differentialdiagnosen des schmerzhaften Hüftgelenks werden im Kap. 10.2 weiter vertieft.

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Authors and Affiliations

  1. Centrum für MuskuloSkeletale Chirurgie, Charité – Universitätsmedizin Berlin, Campus Charité Mitte (CCM) Charitéplatz 1, 10117, Berlin, Deutschland

    Univ.-Prof. Dr. Carsten Perka

  2. Klinik für Endoprothetik, Allgemeine und Rheumaorthopädie, Orthopädische Klinik Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Deutschland

    Prof. Dr. med. Bernd Fink

  3. Klinik für Orthopädie Centrum für Muskulo-Skeletale Chirurgie, Charité – Universitätsmedizin Berlin, Campus Charité Mitte (CCM) Charitéplatz 1, 10117, Berlin, Deutschland

    Dr. med. Michael Millrose

  4. Klinik für Orthopädie Centrum für Muskulo-Skeletale Chirurgie, Charité – Universitätsmedizin Berlin, Campus Charité Mitte (CCM) Charitéplatz 1, 10117, Berlin, Deutschland

    Dr. med. Ufuk Sentürk & Dr. med. Kathi Thiele

  5. Klinik für Orthopädie und Unfallchirurgie, Katholisches Klinikum Mainz, St. Vincenz und Elisabeth Hospital, An der Goldgrube 11, 55131, Mainz, Deutschland

    Prof. Dr. med. Michael Wagner

  6. Klinik für Orthopädie und Klinik für Unfall- und Wiederherstellungschirurgie, Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    Dr. med. Jörg Schröder

  7. Klinik für Unfall- und Orthopädische Chirurgie, Klinikum Nürnberg Süd, Breslauer Straße 201, 90471, Nürnberg, Deutschland

    Prof. Dr. med. Hermann Josef Bail

  8. Zentrum für Spezial- und Wechselendoprothetik und chirurg. Infektiologie, Zeisigwaldkliniken Bethanien Chemnitz, Zeisigwaldstr. 101, 09130, Chemnitz, Deutschland

    Prof. Dr. med. Rudolf Ascherl

  9. Institut für Transfusionsmedizin, Charité – Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Deutschland

    Prof. Dr. med. Axel Pruss

  10. Klinik für Allgemeine Orthopädie, Rheumaorthopädie und Endoprothetik, Auguste-Viktoria-Klinik, Am Kokturkanal 2, 32545, Bad Oeynhausen, Deutschland

    Prof. Dr. med. Christian Götze

Authors
  1. Univ.-Prof. Dr. Carsten Perka
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  2. Prof. Dr. med. Bernd Fink
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  3. Dr. med. Michael Millrose
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  4. Dr. med. Ufuk Sentürk
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  5. Prof. Dr. med. Michael Wagner
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  6. Dr. med. Jörg Schröder
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  7. Prof. Dr. med. Hermann Josef Bail
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  8. Prof. Dr. med. Rudolf Ascherl
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  9. Prof. Dr. med. Axel Pruss
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  10. Dr. med. Kathi Thiele
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  11. Prof. Dr. med. Christian Götze
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Corresponding author

Correspondence to Carsten Perka .

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Editors and Affiliations

  1. Forschung und Biomechanik, Universität Ulm / Inst. für Unfallchir., Helmholtzstraße 14, Ulm, 89081, Germany

    Lutz Claes

  2. St. Vinzenz- und Elisabeth-Hospital, Katholisches Klinikum Mainz, An der Goldgrube 11, Mainz, 55131, Germany

    Peter Kirschner

  3. Campus Charité Mitte (CCM), Centrum f. Muskuloskeletale Chirurgie, Charitéplatz 1, Berlin, 10117, Germany

    Carsten Perka

  4. Orthopädische Klinik, König Ludwig Haus, Universität Würzburg, Brettreichstraße 11, Würzburg, 97074, Germany

    Maximilian Rudert

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Perka, C. et al. (2012). Revisionsendoprothetik. In: Claes, L., Kirschner, P., Perka, C., Rudert, M. (eds) AE-Manual der Endoprothetik. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-14646-6_14

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