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Natürlicher Verlauf von Hüftreifungsstörungen und Hüftdysplasie

Eine Metaanalyse publizierter Literatur

The natural history of developmental dysplasia of the hip

A metaanalysis of the published literature

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Zusammenfassung

Für die Behandlung von Hüftdysplasiepatienten in unterschiedlichen Lebensaltern ist eine Einschätzung des natürlichen Verlaufs von Hüftreifungsstörungen erforderlich. Anhand einer systematischen Metaanalyse publizierter Daten soll daher ein Überblick zu Spontanverläufen von Hüftdysplasien in unterschiedlichen Altersabschnitten gegeben und die Ergebnisse unter Berücksichtigung der physiologischen Hüftgelenkentwicklung diskutiert werden.

Die Literaturzusammenstellung zum Thema „Natürlicher Verlauf von Hüftreifungsstörungen und Hüftdysplasie“ erfolgte über eine systematische Erfassung der von 1975 bis einschließlich Ende 2007 publizierten Veröffentlichungen in medizinischen Datenbanken. Für eine entsprechende Analyse wurden diejenigen Arbeiten ausgewählt, die einen möglichst hohen Evidenzgrad aufwiesen.

Im Kindesalter muss ein dysplastisches Hüftgelenk mit luxierter oder subluxierter Stellung einer Therapie zugeführt werden, da der natürliche Verlauf ansonsten unweigerlich in einer Dysplasiekoxarthrose mündet. Stabile, gut zentrierte Hüftgelenke haben dagegen ein hohes Potenzial, in der weiteren Entwicklung eine physiologische Form anzunehmen. Die publizierte Datenlage hinsichtlich des natürlichen Verlaufs von milden Restdysplasien nach abgeschlossenem Wachstum zeigt keine einheitlichen Ergebnisse in der Relevanz für die Koxarthroseentstehung.

Aufgrund des geringen Evidenzgrades der verfügbaren Studien ist v. a. der Zusammenhang zwischen einer milden Hüftdysplasie im Erwachsenalter und der Entwicklung einer Koxarthrose noch nicht ausreichend geklärt. Dafür sind größere, prospektiv angelegte, epidemiologische Studien erforderlich.

Abstract

Assessment of the natural history of developmental dysplasia of the hip (DDH) is indispensable for age-dependent treatment of these patients. Based on a systematic metaanalysis of the published literature, this study gives an overview of the spontaneous course of DDH in different age decades. Furthermore, these results are discussed in the context of physiologic development of the hip.

The data were compiled by a systematic literature search of medical databases from 1975 through 2007. For this evaluation, only papers that presented as high a level of evidence as possible were included.

In early childhood, DDH with subluxation or dislocation necessitates treatment; otherwise, the spontaneous course leads invariably to osteoarthritis of the hip. However, a stable, well-centered dysplastic hip has a high potential of developing as a physiologic joint. In the analyzed data, an association between mild or moderate DDH after the end of growth and the development of osteoarthritis could not be demonstrated.

The level of evidence of existing data is not sufficient to determine that persisting mild dysplasia is a relevant ethiopathological factor for osteoarthrosis of the hip. Therefore, prospective epidemiological studies are required.

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

    J. Ziegler, F. Thielemann, C. Mayer-Athenstaedt & K.-P. Günther

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  1. J. Ziegler
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  2. F. Thielemann
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  4. K.-P. Günther
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Ziegler, J., Thielemann, F., Mayer-Athenstaedt, C. et al. Natürlicher Verlauf von Hüftreifungsstörungen und Hüftdysplasie. Orthopäde 37, 515–524 (2008). https://doi.org/10.1007/s00132-008-1238-0

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