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Endoprothetische Versorgung bei osteoporoseassoziierter Koxarthrose

Aspekte zur sicheren Patientenversorgung

Endoprosthetic treatment of osteoporosis-related coxarthrosis

Aspects of safe patient treatment

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Zusammenfassung

Hintergrund

Mit steigender Lebenserwartung steigt auch die Prävalenz der Arthrose relevant an. Der typische Patient mit operationsbedürftiger Osteoarthrose zwischen 65 und 75 Lebensjahren weist zu 20–25 % eine bisher unerkannte Osteoporose auf.

Fragestellung

Welcher Ablauf bietet sich für die Abklärung einer eventuellen Osteoporose präoperativ an? Welche Schlussfolgerungen werden für die operative Versorgung und die Nachbehandlung daraus gezogen?

Material und Methode

Die zur Verfügung stehende Literatur zur Erkrankungsprävalenz der Osteoporose, perioperativen Komplikationen bei Hüftendoprothesen, ausgewählte Registerinformationen, die Leitlinie zur Diagnostik und Therapie der Osteoporose sowie die einer angemessenen Nachbehandlung wurden in der vorliegenden Übersichtsarbeit zusammengefasst.

Ergebnisse

Die orthopädisch-osteologische Abklärung ermittelt das Frakturrisiko nach Hinweisen des DVO (Dachverband Osteologie) und der Beckenübersichtsaufnahme. Basierend auf der Risikoeinschätzung wird eine Empfehlung zur Implantatwahl und Verankerung gegeben. Wesentliche Risiken der operativen Versorgung einer Koxarthrose bei Osteoporose sind die intraoperative Fraktur und die kurzfristige aseptische Lockerung. In der Nachbehandlung sind ergänzend zur Endoprothesenschule eine suffiziente Sturzprophylaxe und dauerhafte Übungsbehandlung wichtig. Die Dauermedikation sollte auf Risikopräparate der PRISCUS-Liste überprüft werden. Das besondere kardiale Risikoprofil der NSAR (nichtsteroidale Antirheumatika) sollte berücksichtigt und für Patienten mit nachgewiesener Osteoporose eine antiresorptive Therapie eingeleitet werden.

Abstract

Background

With increasing life expectancy the prevalence of osteoarthritis is also substantially rising. Patients aged between 65 and 75 years scheduled for total joint arthroplasty suffer from undetected osteoporosis in 20–25 % of cases.

Objectives

How to determine osteoporosis during preoperative workup? Which conclusions can be drawn for the operation treatment and the postoperative course?

Methods

The literature dealing with the prevalence of osteoporosis, perioperative complications of total hip arthroplasty, selected register informations, guidelines for diagnostics and treatment of osteoporosis and for the postoperative treatment are summarized and discussed.

Results

The fracture risk is determined according to the guidelines of the Dachverband Osteologie (DVO, Governing Body on Osteology). The implant and the anchorage are selected based on the risk of suffering from osteoporosis. An intraoperative fracture and early aseptic loosening are the main operative risk factors. For the postoperative course in addition to education about arthroplasty, adequate support for prevention of falls is mandatory. Continuous physiotherapy with muscular strengthening is advisable. The long-term medication should be checked for risks in the PRISCUS list of potentially inappropriate medication in the elderly and non-steroidal anti-inflammatory drugs (NSAIDs) should not be prescribed in patients with cardiac comorbidities. Patients with confirmed osteoporosis should be treated with antiresorptive agents.

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Interessenkonflikt. S. Kirschner, A. Hartmann, K.-P. Günther, C. Hamann geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl-Gustav Carus, Technische Universität Dresden AöR, Fetscherstr. 74, 01307, Dresden, Deutschland

    S. Kirschner MBA, A. Hartmann, K.-P. Günther & C. Hamann

  2. UniversitätsCentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl-Gustav Carus, Technische Universität Dresden AöR, Dresden, Deutschland

    S. Kirschner MBA

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Kirschner, S., Hartmann, A., Günther, KP. et al. Endoprothetische Versorgung bei osteoporoseassoziierter Koxarthrose. Orthopäde 43, 353–364 (2014). https://doi.org/10.1007/s00132-013-2167-0

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