Skip to main content
SpringerLink
Log in

Gelenkerhaltende Hüftchirurgie im Erwachsenenalter

Beckenosteotomien

Joint preserving surgery of the adult hip

Pelvic osteotomies

  • CME Zertifizierte Fortbildung
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Fehlformen und Fehlstellungen des Azetabulums bei Hüftdysplasie oder Retroversion der Pfanne sind mögliche Ursachen einer Koxarthrose bei jungen Erwachsenen. Die operative Versorgung mit Reorientierung des Azetabulums ermöglicht eine kausale Behandlung mit Behebung der Fehlstellung und Bildung eines natürlichen Gelenks. Etablierte Verfahren sind die periazetabuläre Osteotomie nach Ganz (PAO) sowie die 3-Fach-Beckenosteotomie nach Tönnis und Kalchschmidt (3FBO). Beide Verfahren ermöglichen eine kontrollierte und dreidimensionale Korrektur der Pfannenlage. Aufgrund der jeweils unterschiedlichen Technik weisen sie spezifische Vor- und Nachteile auf, welche im vorliegenden Beitrag erörtert werden. Bei rechtzeitiger Korrektur (Arthrosegrad 0 und 1 nach Tönnis) sind bei korrekter Indikation und präziser Technik gute Ergebnisse zu erwarten.

Abstract

Deformity and malposition of the acetabulum can occur during the development of the hip. Developmental hip dysplasia and acetabular retroversion are possible causes of osteoarthritis in the young adult. Surgical management with reorientation of the acetabulum allows causal therapy of the deformity and preservation of the native hip joint. Established techniques are the Bernese periacetabular osteotomy (PAO) and the Tönnis and Kalchschmidt triple osteotomy of the pelvis. Both techniques permit three-dimensional correction of the position of the acetabulum. Advantages and disadvantages of each technique must be considered and are summarized in the present paper. If performed early (osteoarthritis grade Tönnis 0 and 1) with correct indication and proper technique, good results can be expected.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Ipach I, Mittag F, Syha R et al (2012) Indications for total hip arthroplasty in young adults – idiopathic osteoarthritis seems to be overestimated. Rofo 184:239–247

    Article  PubMed  CAS  Google Scholar 

  2. Harris WH (1986) Etiology of osteoarthritis of the hip. Clin Orthop Relat Res 213:20–33

    PubMed  Google Scholar 

  3. Cooperman DR, Wallensten R, Stulberg SD (1983) Acetabular dysplasia in the adult. Clin Orthop Relat Res 175:79–85

    PubMed  Google Scholar 

  4. Pauwels F (1976) Biomechanics of the normal and diseased hip. Theoretical foundation, technique and results of treatment: an atlas. Springer, Berlin Heidelberg New York

  5. Ganz R, Klaue K, Vinh TS et al (1988) A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res 232:26–36

    PubMed  Google Scholar 

  6. Leunig M, Nho SJ, Turchetto L et al (2009) Protrusio acetabuli: new insights and experience with joint preservation. Clin Orthop Relat Res 467:2241–2250

    Article  PubMed  Google Scholar 

  7. Beck M, Leunig M, Ellis T et al (2003) The acetabular blood supply: implications for periacetabular osteotomies. Surg Radiol Anat 25:361–367

    Article  PubMed  CAS  Google Scholar 

  8. Hempfing A, Leunig M, Notzli HP et al (2003) Acetabular blood flow during Bernese periacetabular osteotomy: an intraoperative study using laser Doppler flowmetry. J Orthop Res 21:1145–1150

    Article  PubMed  Google Scholar 

  9. Katthagen BD, Spies H, Bachmann G (1995) Arterial vascularization of the bony acetabulum. Z Orthop Ihre Grenzgeb 133:7–13

    Article  PubMed  CAS  Google Scholar 

  10. Ponseti IV (1978) Growth and development of the acetabulum in the normal child. Anatomical, histological, and roentgenographic studies. J Bone Joint Surg Am 60:575–585

    PubMed  CAS  Google Scholar 

  11. Ponseti IV (1978) Morphology of the acetabulum in congenital dislocation of the hip. Gross, histological and roentgenographic studies. J Bone Joint Surg Am 60:586–599

    PubMed  CAS  Google Scholar 

  12. Siebenrock KA, Kalbermatten DF, Ganz R (2003) Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res 407:241–248

    Article  PubMed  Google Scholar 

  13. Leunig M, Siebenrock KA, Ganz R (2001) Rationale of periacetabular osteotomy and background work. Instr Course Lect 50:229–238

    PubMed  CAS  Google Scholar 

  14. Reynolds D, Lucas J, Klaue K (1999) Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Am Br 81:281–288

    Article  CAS  Google Scholar 

  15. Tönnis D, Heinecke A (1999) Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 81:1747–1770

    PubMed  Google Scholar 

  16. Janssen D, Kalchschmidt K, Katthagen BD (2009) Triple pelvic osteotomy as treatment for osteoarthritis secondary to developmental dysplasia of the hip. Int Orthop 33:1555–1559

    Article  PubMed  Google Scholar 

  17. Tönnis D (2008) Hüftdysplasie – Was ist bei der dreifachen Beckenosteotomie zu beachten? Z Orthop Unfallchir 146:564–569

    Article  Google Scholar 

  18. Schulitz KP, Roggenland G (1991) Triple osteotomy of the pelvis in dysplastic hip joints in children and adults. Z Orthop Ihre Grenzgeb 129:209–216

    Article  PubMed  CAS  Google Scholar 

  19. Kumar D, Bache CE, O’hara JN (2002) Interlocking triple pelvic osteotomy in severe Legg-Calve-Perthes disease. J Pediatr Orthop 22:464–470

    Article  PubMed  Google Scholar 

  20. Wenger DR, Pandya NK (2011) Advanced containment methods for the treatment of Perthes disease: Salter plus varus osteotomy and triple pelvic osteotomy. J Pediatr Orthop 31:198–205

    Article  Google Scholar 

  21. Myers SR, Eijer H, Ganz R (1999) Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res 363:93–99

    Article  PubMed  Google Scholar 

  22. Clohisy JC, Barrett SE, Gordon JE et al (2005) Periacetabular osteotomy for the treatment of severe acetabular dysplasia. J Bone Joint Surg Am 87:254–259

    Article  PubMed  Google Scholar 

  23. Crockarell J Jr, Trousdale RT, Cabanela ME et al (1999) Early experience and results with the periacetabular osteotomy. The Mayo Clinic experience. Clin Orthop Relat Res 363:45–53

    Article  PubMed  Google Scholar 

  24. Murphy S, Deshmukh R (2002) Periacetabular osteotomy: preoperative radiographic predictors of outcome. Clin Orthop Relat Res 405:168–174

    Article  PubMed  Google Scholar 

  25. Trousdale RT, Ekkernkamp A, Ganz R et al (1995) Periacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips. J Bone Joint Surg Am 77:73–85

    PubMed  CAS  Google Scholar 

  26. Siebenrock KA, Scholl E, Lottenbach M et al (1999) Bernese periacetabular osteotomy. Clin Orthop Relat Res 363:9–20

    Article  PubMed  Google Scholar 

  27. Steppacher SD, Tannast M, Ganz R et al (2008) Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res 466:1633–1644

    Article  PubMed  Google Scholar 

  28. Bremen-Kuhne R von, De La Vega-Salgado H, Steffen R (2006) Triple pelvic osteotomy (according to Tonnis and Kalchschmidt) in the treatment of acetabular dysplasia-medium-term results. Z Orthop Ihre Grenzgeb 144:484–491

    Article  Google Scholar 

  29. Küpper A (2002) Mittelfristige Ergebnisse der dreifachen Beckenosteotomie nach Tönnis. Med. Dissertation, Universität Gießen

  30. Katthagen BD, Zahedi AR (2009) Komplikationen nach Hüftoperation. Orthopade 38:786–795

    Article  PubMed  Google Scholar 

  31. Hussell JG, Rodriguez JA, Ganz R (1999) Technical complications of the Bernese periacetabular osteotomy. Clin Orthop Relat Res 363:81–92

    PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Orthopädische Klinik, Inselspital, Universität Bern, Bern, Schweiz

    L. Büchler

  2. Klinik für Orthopädie, Luzerner Kantonsspital, Luzern, Schweiz

    M. Beck

  3. Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, München, Deutschland

    H. Gollwitzer

  4. ATOS Klinik München, München, Deutschland

    H. Gollwitzer

  5. Orthopädische Klinik, Klinikum Dortmund, Dortmund, Deutschland

    B.D. Katthagen & A.R. Zahedi

Authors
  1. L. Büchler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Beck
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Gollwitzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B.D. Katthagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A.R. Zahedi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Gollwitzer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Büchler, L., Beck, M., Gollwitzer, H. et al. Gelenkerhaltende Hüftchirurgie im Erwachsenenalter. Orthopäde 41, 925–936 (2012). https://doi.org/10.1007/s00132-012-1999-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-012-1999-3

Schlüsselwörter

Keywords

Search

Navigation