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Heterotope Ossifikationen im Rahmen der Hüftendoprothetik

Prophylaxe und Therapie

Heterotopic ossifications in total hip arthroplasty

Prophylaxis and therapy

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Zusammenfassung

Heterotope Ossifikationen (HO) stellen eine häufige und bisweilen schwerwiegende Komplikation nach Hüfttotalendoprothesenimplantation dar. Klinisch bewirkt diese gutartige Knochenneubildung Bewegungseinschränkungen und lokale Schmerzen. Ätiologie und Pathomechanismus sind bislang nicht vollständig geklärt, eine Überexpression von „bone morphogenetic proteins“ und eine Dysregulation des Prostaglandinstoffwechsels erscheinen bedeutsam. Zur Prophylaxe von HO nach Hüfttotalendoprothesenimplantation stehen eine Medikation mit nichtsteroidalen Antirheumatika (NSAR) sowie eine perioperative einmalige lokale Strahlentherapie zur Verfügung, wobei letztere nur bei Patienten mit HO in der Vorgeschichte und additiv nach einer HO-Resektion angewendet werden sollte. Selektive Cyclooxygenase-2-Inhibitoren erscheinen nach bisher vorliegenden Daten eine gegenüber den klassischen NSAR Diclofenac und Indometacin vergleichbare prophylaktische Wirkung zu haben. Die vorliegende Arbeit diskutiert die bisherigen Kenntnisse bzgl. Pathophysiologie und Risikofaktoren sowie die klinischen Empfehlungen zur Prophylaxe und Therapie von HO.

Abstract

Heterotopic ossification (HO) is a frequent and occasionally severe complication after total hip arthroplasty. Clinical symptoms of this benign abnormal bone formation are loss of mobility and local pain. The etiology and pathomechanisms are not yet completely understood. Overexpression of bone morphogenetic proteins and dysregulation of prostaglandin metabolism seem to be relevant. Medication with non-steroidal anti-inflammatory drugs (NSAIDs) and perioperative single dose radiotherapy are used for prophylaxis, whereby radiotherapy should only be performed in patients with a history of HO or additionally after resection of HO. From currently available data selective cyclooxygenase-2 inhibitors seem to have a preventive efficacy equal to the classical NSAIDs diclofenac and indometacin. This work discusses current knowledge about the pathophysiology, risk factors and the clinical approach for prevention and treatment of HO.

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  1. Klinik für Orthopädie und Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    J. Schauwecker, F. Pohlig, A. Toepfer, H. Gollwitzer & R. von Eisenhart-Rothe

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  1. J. Schauwecker
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  2. F. Pohlig
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Correspondence to J. Schauwecker.

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Schauwecker, J., Pohlig, F., Toepfer, A. et al. Heterotope Ossifikationen im Rahmen der Hüftendoprothetik. Orthopäde 40, 500–505 (2011). https://doi.org/10.1007/s00132-011-1759-9

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