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Megapfannen und Beckenteilersatz

Mega cups and partial pelvic replacement

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Zusammenfassung

Komplexe Defektsituationen, wie sie im Rahmen von endoprothetischen Revisionsoperationen und nach Resektion von Tumoren des Beckens auftreten können, sind für Operateur und Implantat nach wie vor eine Herausforderung. Ziel der Rekonstruktion ist es, trotz z. T. ausgedehnter Knochendefekte eine primärstabile Verankerung des Revisionsimplantats im autochthonen Knochenlager sowie möglichst die Wiederherstellung des Hüftrotationszentrums zu erreichen. Für die Rekonstruktion azetabulärer Defekte steht heute eine Vielzahl unterschiedlicher Implantate und Techniken zur Verfügung. Während erst- und zweitgradige Defekte entsprechend der Klassifikation nach D’Antonio häufig noch mit Standardimplantaten versorgt werden können, verlangen insbesondere Defekte mit mit Beteiligung des hinteren Pfeilers oder eine bestehende Beckendiskontinuität besondere Beachtung bei der Operationsplanung und der Wahl des Implantats. Intention dieser Arbeit ist es, die wichtigsten endoprothetischen Versorgungsmöglichkeiten azetabulärer Knochendefekte Grad III und IV nach D’Antonio aufzuzeigen sowie Vor- und Nachteile der verwendeten Implantate zu diskutieren.

Abstract

Extensive bone loss, as encountered in both revision arthroplasty of the hip and after resection of malignant tumors of the pelvis, is a major challenge for the surgeon as well as for the revision implant. The aims are, despite extensive acetabular defects, to achieve a primary and load-stable fixation of the revision prosthesis in the pelvic bone as well as restoring the physiological joint biomechanics. At present, a large number of different alloarthroplastic revision implants and complex techniques are available for reconstruction of acetabular deficiencies. According to D’Antonio’s classification of acetabular defects, particularly high-grade defects with loss of the posterior column or a pelvic discontinuity require special attention regarding implant selection and surgical planning. The object of this paper is to highlight the most important tools and techniques of endoprosthetic reconstruction for grade III and IV defects (D’Antonio) of the acetabulum by means of a classification-oriented therapeutic concept and to discuss the pros and cons of the particular implant.

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Klinikum Rechts der Isar der TU München, Ismaningerstraße 22, 81675, München, Deutschland

    R. von Eisenhart-Rothe Dipl.-Kfm., H. Gollwitzer, A. Toepfer, H. Pilge, H. Rechl & R. Gradinger

  2. Orthopädische Klinik, König-Ludwig-Haus, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland

    B.M. Holzapfel

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  1. R. von Eisenhart-Rothe Dipl.-Kfm.
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  2. H. Gollwitzer
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  3. A. Toepfer
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  4. H. Pilge
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  5. B.M. Holzapfel
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  6. H. Rechl
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  7. R. Gradinger
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Correspondence to R. von Eisenhart-Rothe Dipl.-Kfm..

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von Eisenhart-Rothe, R., Gollwitzer, H., Toepfer, A. et al. Megapfannen und Beckenteilersatz. Orthopäde 39, 931–941 (2010). https://doi.org/10.1007/s00132-009-1568-6

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