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Hüftendoprothetik bei posttraumatischer Koxarthrose

Total hip arthroplasty for posttraumatic coxarthritis

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Hintergrund

Frakturen im Bereich des Hüftgelenks stellen schwerwiegende Verletzungen dar. Sie prädisponieren und beschleunigen degenerative Veränderungen am Gelenk. Das klinische Bild einer posttraumatischen Koxarthrose indiziert häufig einen endoprothetischen Ersatz. Aufgrund bestehender knöcherner Defekte und einliegenden Osteosynthesematerials stellen diese Eingriffe besondere Herausforderungen dar.

Material und Methode

Im Beitrag wird ein Überblick über Diagnostik und endoprothetische Therapie bei posttraumatischer Koxarthrose gegeben. Weiterhin werden operative Techniken und Implantatwahl dargestellt.

Ergebnisse

Die Analyse des initialen Traumas, der osteosynthetischen Versorgung, der bestehenden Defektsituation und der degenerativen Veränderung an Femur und Azetabulum stellt die Basis der weiteren Operationsplanung. Mithilfe der Bildgebung ist zu prüfen, welche Verankerungsmöglichkeiten für das Implantat bei bestehender Defektsituation zu wählen sind. Die Notwendigkeit zur Entfernung einer Osteosynthese ist zu prüfen und hierfür benötigtes Material vorzuhalten. Die notwendige Exposition für die sichere Implantation der Endoprothese muss bei der Wahl des Zugangs bedacht werden.

Schlussfolgerung

Verglichen mit der Primärendoprothetik des Hüftgelenks ist die endoprothetische Behandlung der posttraumatischen Koxarthrose komplexer und komplikationsträchtiger. Eine genaue Analyse der knöchernen Defektsituation ist notwendig. Die Beherrschung verschiedenster Zugangswege, der Umgang mit unterschiedlichsten Primär- und Revisionssystemen ist gefordert, um eine Rekonstruktion der Hüftgeometrie auch in der posttraumatischen Defektsituation zu erreichen.

Abstract

Background

Fractures in the region of the hip joint represent severe injuries, which predispose to and accelerate degenerative alterations of the hip joint. The clinical picture of posttraumatic coxarthritis is often an indication for arthroplasty. Total hip arthroplasty for posttraumatic arthritis presents particular technical challenges due to bone deformities and retained implants.

Material and methods

This article gives an overview of the diagnostics and endoprosthetic treatment of posttraumatic coxarthritis. In addition, the operative techniques and implant choice in total hip arthroplasty are presented.

Results

The analysis of the initial trauma, osteosynthetic treatment and implants, bony defects and degenerative changes of the femur and acetabulum is crucial for further surgical planning. Radiological imaging includes computed tomography (CT) to investigate which anchorage option should be selected for the implant in the existing defect situation. Careful preoperative planning is necessary with respect to the surgical approach, hardware removal strategy and bone stock evaluation to achieve a safe and stable implantation of the endoprosthesis.

Conclusion

Total hip arthroplasty for posttraumatic coxarthritis is more complex and demanding than a primary arthroplasty in degenerative arthritis. It is associated with a higher incidence of complications and resembles in some respects revision arthroplasty. An exact analysis of the bony defect situation is necessary. A command of very different access approaches and expertise in the various primary and revision systems are necessary to achieve a reconstruction of hip geometry even in posttraumatic defect situations.

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Literatur

  1. Archibeck MJ, Carothers JT, Tripuraneni KR, White RE Jr (2013) Total hip arthroplasty after failed internal fixation of proximal femoral fractures. J Arthroplasty 28:168–171

    Article  Google Scholar 

  2. Bellabarba C, Berger RA, Bentley CD et al (2001) Cementless acetabular reconstruction after acetabular fracture. J Bone Joint Surg Am 83-A:868–876

    Article  CAS  Google Scholar 

  3. Bercik et al (2012) J Arthroplasty 27:117–121

    Article  Google Scholar 

  4. Carroll EA, Huber FG, Goldman AT et al (2010) Treatment of acetabular fractures in an older population. J Orthop Trauma 24(10):637–644

    Article  Google Scholar 

  5. DeHaan AM, Groat T, Priddy M et al (2013) Salvage hip arthroplasty after failed fixation of proximal femur fractures. J Arthroplasty 28:855–859

    Article  Google Scholar 

  6. EPRD Jahresbericht (2017)

  7. Frank C, Siozos P, Wentzensen A et al (2010) Hüftendoprothese bei Koxarthrose nach Azetabulumfrakturen. Unfallchirurg 113:1013–1022

    Article  CAS  Google Scholar 

  8. Günther KP, Kirschner S, Stiehler M, Goronzy J, Zobel F, Hartmann A (2012) Revisions- und Wechselendoprothetik. Orthop Unfallchir Up2date 7(6):507–524

    Google Scholar 

  9. Helfet DL, Borrelli J, DiPasquale T, Sanders R (1992) Stabilization of acetabular fractures in elderly patients. J Bone Joint Surg Am 74(5):753–765

    Article  CAS  Google Scholar 

  10. Hessmann MH, Nijs S, Rommens PM (2002) Acetebular fractures in the elderly. Results of a sophisticated treatment concept. Unfallchirurg 105:893–900

    Article  CAS  Google Scholar 

  11. Kellam P et al (2016) Systematic review and meta-analysis of avascular necrosis and posttraumatic arthritis after traumatic hip dislocation. J Orthop Trauma 30(1):10–16

    Article  Google Scholar 

  12. Letournel E (1980) Acetabulum fractures: classification and management. Clin Orthop Relat Res 151:81

    Google Scholar 

  13. Mabry TM, Prpa B, Haidukewych GJ, Harmsen WS, Berry DJ (2004) Long-term results of total hip arthroplasty for femoral neck fracture nonunion. J Bone Joint Surg Am 86-A:2263–2267

    Article  Google Scholar 

  14. Makridis KG, Obakponovwe O, Bobak P, Giannoudis PV (2014) Total hip arthroplasty after acetabular fracture: incidence of complications, reoperation rates and functional outcomes: evidence today. J Arthroplasty. https://doi.org/10.1016/j.arth.2014.06.001

    Article  PubMed  Google Scholar 

  15. Matta JM (1996) Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 78:1632

    Article  CAS  Google Scholar 

  16. Matta JM, Merritt PO (1988) Displaced acetabularfractures. Clin Orthop Relat Res 230:83–97

    Google Scholar 

  17. Mayo K (1994) Open reduction and internal fixation of fractures of the Azetabulum. Clin Orthop 05:31–37

    Google Scholar 

  18. McKinley JC, Robinson CM (2002) Treatment of displaced intracapsular hip fractures with total hip arthroplasty: comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation. J Bone Joint Surg Am 84-A:2010–2015

    Article  CAS  Google Scholar 

  19. Total ML (2018) Hip arthroplasty for posttraumatic conditions. J Am Acad Orthop Surg. https://doi.org/10.5435/JAAOS-D-17-00775

    Article  Google Scholar 

  20. Morison Z, Moojen DJ, Nauth A et al (2016) Total hip arthroplasty after acetabular fracture is associated with lower survivorship and more complications. Clin Orthop Relat Res 474:392–398

    Article  Google Scholar 

  21. Paprosky WG, Perona PG, Lawrence J (1994) Acetabular defect classification and surgical reconstruction in revision arthroplasty. J Arthroplast 9:33–44

    Article  CAS  Google Scholar 

  22. Ranawat A, Zelken J, Helfet D, Buly R (2009) Total hip arthroplasty for posttraumatic arthritis after acetabular fracture. J Arthroplast 24(5):759–767

    Article  Google Scholar 

  23. Romness DW, Lewallen DG (1990) Total hip arthroplasty after fracture of the acetabulum: Long-term results. J Bone Joint Surg Br 72:761–764

    Article  CAS  Google Scholar 

  24. Schmidt-Rohlfing B, Reilmann H, Pape HC (2010) Azetabulumfraktur. Unfallchirurg 113:217–229

    Article  CAS  Google Scholar 

  25. Statistisches Bundesamt (2014) DRG Statistik

    Google Scholar 

  26. Tassinari E, Sudanese A, Traina F et al (2008) Total hip arthroplasty in a patient affected by post-traumatic acetabular non-union: case report and review of the literature. Hip Int 18:324

    Article  CAS  Google Scholar 

  27. von Roth P, Abdel MP, Harmsen WS, Berry DJ (2015) Total hip arthroplasty after operatively treated acetabular fracture: a concise follow-up, at a mean of twenty years, of a previous report. J Bone Joint Surg Am 97:288–291

    Article  Google Scholar 

  28. Zhang L et al (2011) Total hip arthroplasty for failed treatment of acetabular fractures: a 5-year follow-up study. J Arthroplasty 26:1189–1193

    Article  Google Scholar 

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Authors and Affiliations

  1. BG Unfallklinik Frankfurt am Main gGmbH, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland

    S. M. Heinz, R. Hoffmann & M. Kremer

Authors
  1. S. M. Heinz
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  2. R. Hoffmann
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  3. M. Kremer
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Correspondence to S. M. Heinz.

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Interessenkonflikt

S.M. Heinz, R. Hoffmann und M. Kremer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Heinz, S.M., Hoffmann, R. & Kremer, M. Hüftendoprothetik bei posttraumatischer Koxarthrose. Trauma Berufskrankh 21, 24–30 (2019). https://doi.org/10.1007/s10039-019-0420-4

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  • DOI: https://doi.org/10.1007/s10039-019-0420-4

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