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Langzeitergebnisse zementfreier Hüftendoprothesenschäfte

Analyse der Überlebensraten mit einem Nachuntersuchungszeitraum von mindestens 15 Jahren

Long-term results of uncemented stems in total hip arthroplasty

Analysis of survival rates with a minimum 15-year follow-up

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Zusammenfassung

Hintergrund

Der Anteil der Versorgung mit zementfreien Endoprothesenschäften im Rahmen des primären endoprothetischen Ersatzes des Hüftgelenks steigt stetig an. Trotz der kontinuierlichen Weiterentwicklung zementfreier Schaftmodelle liegen für zementfreie Schaftimplantate – im Gegensatz zu den umfassenden Daten zu Überlebensraten zementierter Hüftendoprothesenschäfte – nur spärliche Langzeitergebnisse vor. Angesichts des zunehmenden Aktivitätsanspruches der Patienten bis in das hohe Alter und des steigenden Kostendruckes im Gesundheitssystem sind Langzeitergebnisse zementfreier Implantate von essentieller Bedeutung, um deren klinischen Einsatz gegenüber Patienten und Kostenträgern weiterhin rechtfertigen zu können.

Material und Methoden

Es wurde eine systematische Literaturanalyse in Medline zu Langzeitergebnissen zementfreier Hüftendoprothesenschäfte nach Primärimplantation durchgeführt, wobei rigide Einschlusskriterien bezüglich Patientenzahl (Kollektivgröße n>50 Hüften für Einzelstudien, n>150 Hüften für Registerdaten), Nachuntersuchungszeitraum (mindestens 15 Jahre) und Vollständigkeit der Nachuntersuchung (<10% des Kollektivs im Verlauf verloren) aufgestellt wurden. In einer Literaturübersicht werden die vorliegenden Langzeitergebnisse aus Einzelstudien mit einem mittleren Nachuntersuchungszeitraum von mindestens 15 Jahren sowie die 15-Jahres-Überlebensraten aus Registerdaten dargestellt.

Ergebnisse

Es wurden 19 Studien (17 Einzelstudien, 2 Studien zu Registerdaten) zu 16 verschiedenen Schaftmodellen identifiziert, die den Einschlusskriterien entsprachen. Die hier vorliegenden ersten langfristigen Ergebnisse zementfreier Hüftendoprothesenschäfte weisen für die meisten nachuntersuchten Implantate altersunabhängige Überlebensraten von >90% nach 15 Jahren auf.

Schlussfolgerungen

Bis auf wenige Ausnahmen liegen für die meisten nachuntersuchten zementfreien Schaftimplantate gute und teilweise exzellente Langzeitergebnisse vor, die mit den bekannten Resultaten der zementierten Schäfte vergleichbar sind und die guten mittelfristigen Ergebnisse zementfreier Hüftendoprothesenschäfte bestätigen. Daher sollte die zementfreie femorale Versorgung im Rahmen primärer endoprothetischer Eingriffe am Hüftgelenk bei allen Patienten mit adäquater Knochenqualität in Betracht gezogen werden.

Abstract

Background

The use of uncemented femoral components in primary total hip arthroplasty has become a standard procedure with increasing numbers. In contrast to the well-established long-term results of cemented femoral stems, true long-term data on the survival of uncemented femoral components are rare. With regard to high patient demands and increasing cost pressures in the public health system, long-term outcomes of uncemented femoral stems are crucial to further support their clinical use.

Material and methods

We conducted a systematic literature research in Medline to obtain long-term survival rates of uncemented femoral stems. Strict inclusion criteria concerning patient numbers (n>50 hips for single studies, n>150 hips for register data), follow-up time (minimum 15 years), and patients lost to follow-up (<10%) were established to identify substantial studies. The minimum 15-year survival rates of published single studies and data from arthroplasty registers were extracted in a literature analysis.

Results

Nineteen studies (17 single studies and two studies with data from arthroplasty registers) that met the inclusion criteria were identified. Survival rates for 16 different uncemented femoral stems were obtained. For most implants included in the study, the long-term outcomes of uncemented femoral components in total hip arthroplasty show minimum 15-year survival rates of over 90% independent of patient age.

Conclusion

The long-term results with a minimum follow-up of 15 years are good or excellent for most studied uncemented femoral stems and are comparable to the outcomes of cemented femoral components. The existing data confirm the previously reported promising midterm results. Therefore, the clinical use of uncemented femoral stems should be considered a reliable treatment option for all patients with adequate bone quality.

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  1. Orthopädische Universitätsklinik, Schlierbacher Landstraße 200 a, 69118, Heidelberg, Deutschland

    C. Merle, M. Clarius &  P.R. Aldinger

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  1. C. Merle
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  2. M. Clarius
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  3. P.R. Aldinger
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Correspondence to P.R. Aldinger.

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Merle, C., Clarius, M. & Aldinger, P. Langzeitergebnisse zementfreier Hüftendoprothesenschäfte. Orthopäde 39, 80–86 (2010). https://doi.org/10.1007/s00132-009-1476-9

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