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Azetabuläre Defektrekonstruktion in der Revisionschirurgie der Hüfte

Autolog, homolog, Metall?

Acetabular defect reconstruction in revision surgery of the hip

Autologous, homologous or metal?

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Zusammenfassung

Die Behandlung periprothetischer Knochendefekte am Acetabulum stellt eine therapeutische Herausforderung in der Revisionschirurgie der Hüfte dar. Ziel sollte neben der Wiederherstellung der physiologischen Gelenkbiomechanik sowie der primär- und belastungsstabilen Verankerung des Revisionsimplantats am vitalen Beckenknochen die biologische Rekonstruktion knöcherner azetabulärer Defekte mit Wiederherstellung eines tragfähigen Pfannenlagers sein. Dabei sollte der biologische Wiederaufbau des Pfannenlagers ein sog. „down grading“ der azetabulären Defektsituation vor dem Hintergrund eines erneuten Revisionseingriffs beinhalten.

Für die Rekonstruktion azetabulärer Defekte stehen heutzutage eine Vielzahl von Implantaten und Rekonstruktionsverfahren zur Verfügung. Kontrovers wird derzeit die Wahl der geeigneten Materialien (ossär vs. metallisch) zur Wiederherstellung eines tragfähigen Pfannenlagers diskutiert.

Dieser Artikel beleuchtet die verschiedenen Möglichkeiten der Rekonstruktion azetabulärer Knochendefekte unter Berücksichtigung der derzeitigen Erkenntnisse der wissenschaftlichen Literatur.

Abstract

The treatment of periprosthetic bone defects of the acetabulum is a therapeutic challenge in hip revision surgery. The aims are the biological reconstruction of osseous acetabular defects and the restoration of a load-bearing acetabular bone stock as well as restoring the physiological joint biomechanics and achieving primary and load-stable fixation of the revision graft in the vital pelvic bone. The biological reconstruction of the acetabular bone stock should include what is referred to as “down-grading” of the acetabular defect situation in case a repeat revision procedure becomes necessary.

Nowadays, a large variety of grafts and reconstruction procedures are available for the reconstruction of acetabular defects. The choice of suitable materials (osseous or metallic) for the restoration of a load-bearing acetabular bone stock is currently the subject of controversial discussion.

This article reviews the various options for the reconstruction of acetabular bone defects taking into consideration the current findings in the scientific literature.

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland

    S. Gravius, G. Pagenstert, O. Weber, H. Röhrig & D.C. Wirtz

  2. Klinik für Orthopädie und Unfallchirurgie, Helios-Klinikum, Siegburg, Deutschland

    N. Kraska

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  1. S. Gravius
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Correspondence to S. Gravius.

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Gravius, S., Pagenstert, G., Weber, O. et al. Azetabuläre Defektrekonstruktion in der Revisionschirurgie der Hüfte. Orthopäde 38, 729–740 (2009). https://doi.org/10.1007/s00132-009-1428-4

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