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Knorpelregenerative Eingriffe am Hüftgelenk

Was ist machbar?

Cartilage regeneration surgery on the hip

What is feasible?

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  • Published:
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Zusammenfassung

Lokalisierte Knorpelschäden am Hüftgelenk werden hauptsächlich durch präarthrotische Deformitäten, insbesondere durch das femoroazetabuläre Impingement (FAI) vom Typ Cam ausgelöst. Die vorzeitige Beseitigung symptomatischer Deformitäten kann die Progredienz lokalisierter Knorpelschäden verhindern. Diese sind meist am anterolateralen Acetabulum lokalisiert und können sowohl offen als auch arthroskopisch versorgt werden. Zur Behandlung eignen sich knochenmarkstimulierende Verfahren mit und ohne Applikation von Biomaterialien sowie die autologe Knorpelzelltransplantation. In ausgewählten Fällen kann durch biologische Maßnahmen der Versuch der Readaption des geschädigten Knorpels vorgenommen werden. Im vorliegenden Artikel wird die aktuelle Studienlage zu den genannten Verfahren näher beleuchtet und ein Ausblick auf mögliche zukünftige Verfahren gegeben.

Abstract

Localized cartilage defects at the hip are mainly caused by pre-arthritic deformities, particularly by cam-type femoroacetabular impingement (FAI). Timely elimination of symptomatic deformities can prevent further progression such as cartilage defects. As the defects mostly occur in the anterolateral part of the acetabulum, they can be easily treated either by open surgery or by arthroscopy. To date the most effective methods of treatment are bone marrow stimulation, with or without a covering of biomaterials, and autologous chondrocyte transplantation. In selected cases, readaptation of the damaged cartilage can be attempted by biological procedures. In the present article, the findings reported in current studies on these procedures are summarized and discussed in detail. An outlook is given regarding possible future treatment concepts.

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Abbreviations

ACT:

Autologe Knorpelzelltransplantation

AMIC:

Autologe matrixinduzierte Chondrogenese

ATMP:

Arzneimittel für neuartige Therapien

BM-MNC:

Bone marrow mononuclear cells

CE-Winkel:

Centrum-Ecken-Winkel

CPM:

„Continuous passive motion“

DDH:

„Developmental dysplasia of the hip“

DGOU:

Deutsche Gesellschaft für Orthopädie und Unfallchirurgie

FAI:

Femoroazetabuläres Impingement

HOS:

Hip Outcome Score

KMV:

Knochenmarkstimulierende Verfahren

MACT:

Matrixgekoppelte autologe Knorpelzelltransplantation

MFx:

Mikrofrakturierung

mHHS:

Modified Harris Hip Score

MOCART:

„Magnetic resonance observation of cartilage repair tissue“

MPZ:

Mesenchymale Progenitorzellen

NAHS:

Non-Arthritic Hip Score

WOMAC:

Western Ontario and McMaster Universities Osteoarthritis Index

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland

    Stefan Landgraeber & Marcus Jäger

  2. Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland

    Stefan Fickert

  3. sporthopaedicum Straubing/Regensburg, Bahnhofplatz 27, 94315, Straubing, Deutschland

    Stefan Fickert

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  1. Stefan Landgraeber
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Correspondence to Stefan Landgraeber.

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Interessenkonflikt

S. Landgraeber gibt an, dass er dreimal eine Aufwandsentschädigung für Vorträge von B. Braun erhalten hat, S. Fickert gibt einen Beratervertrag bei Tetec/B. Braun und Codon an. M. Jäger gibt an, dass kein Interessenkonflikt besteht.

Zur Erstellung des Beitrages wurden durch die Autoren keine Untersuchungen an Menschen und Tieren durchgeführt.

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Landgraeber, S., Jäger, M. & Fickert, S. Knorpelregenerative Eingriffe am Hüftgelenk. Orthopäde 46, 928–937 (2017). https://doi.org/10.1007/s00132-017-3491-6

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