Zusammenfassung
Operationsziel
Aufhebung eines femoroazetabulären Impingementkonflikts und Herstellung eines schmerzfreien, normalen Bewegungsumfangs.
Indikationen
Femoroazetabuläres Impingement jeglicher Art (Cam/Pincer) und Lokalisation (anterior/posterior).
Kontraindikationen
Absolut: Fortgeschrittene Koxarthrose, Infektionen im Bereich des Operationssitus.
Relativ: Massive Retroversion des Azetabulums mit defizitärer Hinterwand.
Operationstechnik
Chirurgische Hüftluxation: Seitenlage. Gerade laterale Inzision über dem Trochanter major und Eingehen in das Gibson-Intervall. Digastrische Trochanterosteotomie unter Schonung des tiefen Astes der Arteria circumflexa femoris medialis. Eröffnung des Intervalls zwischen Musculus piriformis und Musculus gluteus minimus. Z-förmige Kapsulotomie. Luxation des Femurkopfes. Ablösen des Labrums. Trimmen des azetabulären Überstands. Refixation des Labrums. Herstellung eines suffizienten femoralen Kopf-Hals-Übergangs. Kapselnaht. Refixation des Trochanters.
Weiterbehandlung
Während der Hopitalisierung regelmäßige Behandlung auf der passiven Bewegungsschiene mit maximal 90° Flexion. Keine aktive Abduktion, keine passive Adduktion über die Mittellinie, kein Heben des gestreckten Beins, 10–15 kg Teilbelastung an zwei Unterarmgehstöcken während 6 Wochen. Anschließend erste klinische und radiologische Nachkontrolle und je nach Befund schrittweiser Übergang zur Vollbelastung. Thromboseprophylaxe bis zur Vollbelastung.
Ergebnisse
Kurz- und mittelfristig fand sich eine Verbesserung des postoperativen klinischen Scores (Merle-d’Aubigné-Score) bei 95% aller Patienten, je nach vorbestehendem Arthrosegrad. Gute bis exzellente Ergebnisse wurden in 91% der Fälle erzielt. Die kumulative 5-Jahres-Überlebensrate betrug 91% (Endpunkt Hüfttotalprothese oder schwacher Merle-d’Aubigné-Score). Langzeitergebnisse stehen noch aus.
Abstract
Objective
Elimination of an intraarticular femoroacetabular impingement conflict. Creation of a pain-free, normal range of motion of the hip.
Indications
Femoroacetabular impingement of any type (cam/pincer) and any localization (anterior/posterior).
Contraindications
Absolute: advanced hip osteoarthritis, local infections around the hip.
Relative: excessive acetabular retroversion with deficiency of the posterior wall.
Surgical Technique
Lateral decubitus position. Straight lateral incision centered over the greater trochanter. Entering of the Gibson interval. Digastric trochanteric osteotomy with protection of the medial circumflex femoral artery. Opening of the interval between the piriformis and the gluteus minimus muscle. Z-shaped capsulotomy. Dislocation of the femoral head. Detachment of the labrum. Trimming of the excessive acetabular rim. Refixation of the labrum. Creation of a sufficient femoral head-neck offset. Suture of the capsule. Refixation of the trochanter.
Postoperative Management
During hospital stay, intensive mobilization of the hip joint using a continuous passive motion machine with a maximum flexion of 90°. No active abduction and passive adduction over the body’s midline. Maximum weight bearing 10–15 kg for 6 weeks. Subsequently, first clinical and radiographic follow-up. Deep venous thrombosis prophylaxis until full weight bearing.
Results
Short- and mid-term results showed an improvement of the postoperative clinical score (Merle d’Aubigné Score) in 95% of all patients, depending on the individual degenerative joint alterations at the time of surgery. Good to excellent results were obtained in 91% of all cases. Cumulative 5-year survival was 91% (endpoint total hip arthroplasty or poor Merle d’Aubigné Score). Long-term results are not available yet.
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Tannast, M., Siebenrock, KA. Die offene Therapie des femoroazetabulären Impingements. Orthop Traumatol 22, 3–16 (2010). https://doi.org/10.1007/s00064-010-3001-7
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DOI: https://doi.org/10.1007/s00064-010-3001-7