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Gute und schlechte Indikationen für die Hüftarthroskopie

Good and bad indications for hip arthroscopy

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Hintergrund

Die arthroskopische Therapie von Hüftgelenkerkrankungen ist technisch anspruchsvoll. Ein kräftiger Weichteilmantel, eine straffe Kapsel sowie die knöcherne Form der Hüfte erschweren den Zugang ins Gelenk und limitieren die Möglichkeiten sowohl der Visualisierung als auch der Behandlung.

Fragestellung

Es werden eine Übersicht über die aktuellen Indikationen der Hüftgelenkarthroskopie gegeben und diese mit alternativen Behandlungsmethoden verglichen.

Material und Methode

Die technische Entwicklung der Hüftarthroskopie wird aufgezeigt und es werden gute und schlechte Indikationen anhand aktueller Literatur und Expertenempfehlungen diskutiert.

Ergebnisse

Nach der Erstbeschreibung einer Hüftarthroskopie im Jahr 1931 verblieben die Indikationen technisch bedingt sehr limitiert und beschränkten sich größtenteils auf diagnostische Eingriffe. Durch eine stetige Weiterentwicklung und Verbesserung der operativen Technik, Instrumente und Optiken entwickelte sich die Hüftarthroskopie innerhalb der letzten 10 Jahre jedoch zu einem orthopädischen Standardverfahren mit deutlich erweitertem Indikationsspektrum. Ihre Hauptindikation ist die Behandlung des femoroazetabulären Impingements (FAI) und der damit verbundenen Schäden am Labrum und Gelenkknorpel. Weitere Indikationen sind krankhafte Veränderungen der Synovialmembran, die Entfernung freier Gelenkkörper sowie die Therapie periartikulärer Erkrankungen.

Schlussfolgerung

Die Hüftarthroskopie ist eine etablierte Operationstechnik zur sicheren und effizienten Behandlung einer Vielzahl von Hüfterkrankungen. Bei korrekter Indikation und Technik sind die Resultate mit denen der offenen Chirurgie vergleichbar bei einer niedrigen Komplikationsrate.

Abstract

Background

Hip arthroscopy is a technically demanding procedure. A thick muscle layer, a strong capsule and the bony shape of the hip make the joint difficult to access and limit visualization and the possibility of treatment.

Objectives

This article provides an overview of current indications for hip arthroscopy and compares these with alternative treatment methods.

Materials and methods

Technical developments in hip arthroscopy are presented and good and bad indications based on current literature and expert recommendations discussed.

Results

After the initial description of hip arthroscopy in 1931, the indications remained very limited for technical reasons and were mainly restricted to diagnostic procedures. As a result of continuous development and improvement of the surgical technique, instruments and optics over the last 10 years, hip arthroscopy has become a standard orthopedic procedure with a significantly broader range of indications. The main indication is the treatment of femoroacetabular impingement (FAI) and related damage to the labrum and articular cartilage. Other indications include pathological changes of the synovial membrane, the removal of free joint bodies and the treatment of periarticular disease.

Conclusions

Hip arthroscopy is an established surgical technique for the safe and efficient treatment of a variety of hip diseases. If the indication is made correctly and the appropriate technique is used, results are comparable to open surgery at a low complication rate.

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  1. Klinik für Orthopädie und Unfallchirurgie, Inselspital Bern, 3010, Bern, Schweiz

    Lorenz Büchler

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  1. Lorenz Büchler
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Correspondence to Lorenz Büchler.

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L. Büchler gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Büchler, L. Gute und schlechte Indikationen für die Hüftarthroskopie. Arthroskopie 31, 318–325 (2018). https://doi.org/10.1007/s00142-018-0228-4

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  • DOI: https://doi.org/10.1007/s00142-018-0228-4

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