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Navigation in der Hüftrevisionsendoprothetik

Navigation in hip joint revision endoprosthetics

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Zusammenfassung

Die exakte, anatomischen und biomechanischen Anforderungen gerechte Prothesenpositionierung kann in der Hüftrevisionsendoprothetik anspruchsvoll sein. Die präoperative Planung lässt sich aufgrund der intraoperativen Situation nicht immer präzise umsetzten. Gerade bei großen Defektsituationen ist die Wiederherstellung des Hüftzentrums, der korrekten Ausrichtung der Pfanne und des Schaftes schwierig. Durch computerassistierte Verfahren ist eine exakte Implantatplatzierung beim primären Hüftgelenkersatz möglich. Obwohl der potenzielle Nutzen in der Revisionsendoprothetik einleuchtet, gibt es hier bislang nur wenige Publikationen, die sich in der Regel auf die Pfannenpositionierung beschränken. Durch die zusätzliche Einbindung der Schaftnavigation und der Implantatdaten wird es durch Analysen des Impingement möglich sein, Bestimmung der Beinlängenänderung, Messung der Schaftantetorsion und weiterer Parameter die Revisionsendoprothetik weiter zu optimieren. Die Navigation kann jedoch nur als Orientierungshilfe verstanden werden und ersetzt nicht mangelnde Kenntnisse und Erfahrung des Operateurs. Die Vorgaben bezüglich der Positionierung der Implantate müssen daher vom Operateur kommen.

Abstract

The exact anatomical and biomechanical demands of correct positioning of prostheses can be critical for hip joint revision endoprosthetics. Preoperative planning cannot always be implemented due to the intraoperative situation. The reconstruction of the hip center, the correct alignment of the acetabulum and the shaft is difficult, especially in large defect situations. An exact positioning of the implant is possible for primary hip joint replacement by computer-assisted procedures. Although the potential benefits of revision endoprosthetics make sense, there are as yet only few publications which as a rule are limited to positioning of the acetabulum. It will be possible to further optimize revision endoprosthetics by analysis of the impingement, determination of alterations in leg length, measurement of shaft antetorsion and other parameters, by additionally incorporating shaft navigation and implant data. Navigation should, however, only be understood as an aid to orientation and does not supplant lack of knowledge and experience on the side of the operator. Information on positioning of the implant must therefore come from the operator.

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  1. Klinik für Unfallchirurgie und Orthopädie, Klinikum Stuttgart – Katharinenhospital, Kriegsbergstraße 60, 70174, Stuttgart, Deutschland

    P.A. Grützner

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  1. P.A. Grützner
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Grützner, P. Navigation in der Hüftrevisionsendoprothetik. Orthopäde 38, 711–717 (2009). https://doi.org/10.1007/s00132-009-1433-7

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  • DOI: https://doi.org/10.1007/s00132-009-1433-7

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