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Operationsplanung und Ergebniskontrolle in der elektiven Hüftendoprothetik

Angewandtes Qualitätsmanagement als Grundlage einer sicheren Patientenversorgung

Templating and radiological outcome monitoring for elective total hip arthroplasty

Applied quality management principles for safe patient care

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Zusammenfassung

Die Implantation einer Hüftendoprothese bei fortgeschrittener Arthrose stellt eine sehr erfolgreiche und zuverlässige Operation dar. Mit der Endoprothesenplanung werden die biomechanische Situation des Hüftgelenks und die zu verwendenden Komponenten sowie die Verankerungstechnik festgelegt.

An einer Kohorte von 114 Patienten wurden die Güte der digitalen Röntgenbilder und der Versorgung bestimmt. Durchschnittlich wurde für die biomechanische Situation eine geringe Beinverlängerung bei guter Offsetrekonstruktion erreicht. In der Gruppe von Patienten mit Versorgung der zweiten Seite war der Beinlängenunterschied geringer. Die verwendeten Komponentenstellungen lagen für die Pfanneninklination durchschnittlich mit 43° bzw. 44° (Gruppe 1 und 2) im publizierten Zielbereich. Die Vorhersagegenauigkeit für die zu verwendenden Komponentengrößen lag für die exakte Größe der Pfanne bei 40% und für den Schaft bei 29%.

Durch eine Variabilität bei der Skalierung wurde eine abnehmende Vorhersagegenauigkeit für die geplanten Komponentengrößen bei digitaler Röntgentechnik gefunden. Die biomechanische Situation und Komponentenstellung zeigt eine gute Versorgungsqualität als Ausdruck eines kontinuierlichen Qualitätsmanagement an. Die Endoprothesenplanung und Ergebnisüberprüfung kann für eine sichere Patientenversorgung empfohlen werden.

Abstract

Implementation of total hip arthroplasty is a successful and reliable treatment for end-stage osteoarthritis. The biomechanics and components as well as the fixation were selected with the aid of templating.

Based on a cohort of 114 patients the quality of digital X-rays and the operative results were determined. There was a slight leg lengthening and a good offset reconstruction in these patients. For the patients with replacement of the second hip the leg lengthening was smaller. The cup inclination was at 43° and 44° within the desired range. The prediction of the exact component size used was 40% for the cup and 29% for the stem.

Through variation in scaling of the digital X-ray a diminishing prediction accuracy was found in our study. The correction of biomechanics and position of components showed good quality in patient care. Templating and assessment of the postoperative result in total hip arthroplasty is a model for continuous quality management and can be recommended for safe patient care.

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  1. Klinik und Poliklinik für Orthopädie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland

    S. Kirschner, C. Hamann, S. Handreka, K.P. Günther & A. Hartmann

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  1. S. Kirschner
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  2. C. Hamann
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  3. S. Handreka
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Correspondence to S. Kirschner.

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Kirschner, S., Hamann, C., Handreka, S. et al. Operationsplanung und Ergebniskontrolle in der elektiven Hüftendoprothetik. Unfallchirurg 114, 776–785 (2011). https://doi.org/10.1007/s00113-011-2029-3

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  • DOI: https://doi.org/10.1007/s00113-011-2029-3

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