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Femoraler Hüftprothesenwechsel

Replacement of femoral hip prostheses

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Zusammenfassung

Der femorale Hüftprothesenwechsel ist technisch anspruchsvoll. Aus diesem Grund ist die exakte präoperative Planung für den Erfolg einer Wechseloperation von entscheidender Bedeutung. Die Vielfalt der möglichen Rekonstruktionsverfahren bei femoraler Defektsituation erschwert den Entscheidungsprozess zusätzlich. Im Rahmen der präoperativen Diagnostik sind deshalb etablierte Klassifikationssysteme bei der Therapieentscheidung unverzichtbar. Intraoperativ müssen geeignete Implantate und Instrumente zur Verfügung stehen, um auf Komplikationen adäquat reagieren zu können. Primäres Ziel der Wechselendoprothetik ist neben der Wiederherstellung der physiologischen Gelenkbiomechanik eine primärstabile Verankerung des Implantats im vitalen Knochen. Vor dem Hintergrund einer möglichen erneuten Revisionsoperation sollten zementfreie Verfahren bevorzugt werden. Modulare Systeme erlauben eine große intraoperative Flexibilität bei der Rekonstruktion des Rotationszentrums. Abhängig von der vorliegenden ossären Defektsituation kann eine Anlagerung von auto- oder allogenen Knochentransplantaten notwendig werden.

Verschiedene Klassifikationssysteme für femorale Defektsituationen werden dargestellt und entsprechende Behandlungsoptionen diskutiert.

Abstract

Femoral revision of total hip arthroplasty is a technically demanding procedure. Therefore, accurate preoperative planning is essential for good clinical results. With many reconstruction methods available, the decision-making process can be complex. Well established classification systems can facilitate preoperative planning. At the time of revision surgery appropriate implants and instruments have to be available ensuring the possibility of managing operative complications. Primary goals of revision arthroplasty are restoration of the physiological joint biomechanics and primary stable fixation of the revision implant. In consideration of possible repeat revision surgery, cementless stem fixation should be preferred. Modular stems provide significant flexibility in restoring the center of rotation. Depending on the pre-existing femoral defect, osseous grafts can be necessary.

The scope and classification systems of femoral osseous defects in revision arthroplasty will be discussed and different treatment options will be outlined, which guide the surgeon in selecting an appropriate method of reconstruction.

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Authors and Affiliations

  1. Orthopädische Klinik, König-Ludwig-Haus, Julius-Maximilians-Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland

    M. Rudert, M. Hoberg & B.M. Holzapfel

  2. Klinik für Orthopädie und Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland

    P.M. Prodinger & R. Gradinger

Authors
  1. M. Rudert
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  2. M. Hoberg
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  3. P.M. Prodinger
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  4. R. Gradinger
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  5. B.M. Holzapfel
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Correspondence to M. Rudert.

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Rudert, M., Hoberg, M., Prodinger, P. et al. Femoraler Hüftprothesenwechsel. Chirurg 81, 299–309 (2010). https://doi.org/10.1007/s00104-009-1844-3

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