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Tribologie in der Hüftendoprothetik

Welches Material hat welchen Nutzen?

Tribology in hip arthroplasty

Benefits of different materials

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Zusammenfassung

Die Wahl der Materialkombination beim künstlichen Hüftgelenkersatz ist von klinischer Relevanz. Der vorliegende Übersichtsartikel betrachtet die technischen Unterschiede hinsichtlich des Verschleißes und der Korrosion der relevanten Materialkombinationen aus Keramik, Metall, keramisiertem Metall und verschiedenen Polyethylenarten. Die Materialeigenschaften, die häufig unter standardisierten Bedingungen im Labor erfasst wurden, werden mit den klinischen Ergebnissen anhand evidenzgraduierter klinischer Studien und auf Basis von Registerstudien verglichen. Diese Arbeit stellt somit als aktuelle Momentaufnahme Erwartungen und tatsächliche klinische Ergebnisse heutiger Materialkombinationen in einen gemeinsamen Kontext. Es zeigt sich, dass sich manche Tendenzen aus der Materialforschung, z. B. zum quervernetzten Polyethylen, mit den Beobachtungen aus der Klinik decken, während bei anderen Materialien technische Vorteile bislang nicht in einen relevanten klinischen Nutzen münden.

Abstract

When it comes to total hip replacements, choosing the suitable material combination is of clinical relevance. The present review article examines the technical differences in wear and corrosion of the relevant material combinations of ceramics, metals, ceramized metals and various types of polyethylene. The material characteristics, which were often tested under standardized conditions in the laboratory, are compared with clinical results on the basis of evidence-graded clinical studies and on the basis of register studies. This article thus represents an up-to-date snapshot of the expectations and actual clinical outcomes of the present choice of material combinations. It shows that some tendencies from the field of materials research, e.g. with regard to cross-linked polyethylene, coincide with observations from practical clinical experience, while for other materials, a proven technical superiority has not yet been confirmed as an evident advantage in clinical practice.

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Abbreviations

ALTR:

„Adverse local tissue reactions“

AOANJRR :

Australian Orthopaedic Association National Joint Replacement Registry

AOXPE :

Antioxidatives quervernetztes Polyethylen

ARR :

Absolute Risikoreduktion

EPRD :

Endoprothesenregister Deutschland

KPE :

Konventionelles Polyethylen

NJR :

National Joint Registry

NNT :

Anzahl der notwendigen Behandlungen

RCT :

Randomisierte kontrollierte Studie

XPE :

Quervernetztes Polyethylen

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  1. Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland

    J. Philippe Kretzer, Maximilian Uhler, Sebastian Jäger, Therese Bormann, Robert Sonntag, Mareike Schonhoff & Stefan Schröder

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J. P. Kretzer ist Mitglied in der Arbeitsgruppe „Evidenzbasierte Medizin in Orthopädie und Unfallchirurgie“ der Deutschen Gesellschaft Für Orthopädie und Unfallchirurgie (DGOU). M. Uhler, S. Jäger, T. Bormann, R. Sonntag, M. Schonhoff und S. Schröder geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Kretzer, J.P., Uhler, M., Jäger, S. et al. Tribologie in der Hüftendoprothetik. Orthopäde 50, 259–269 (2021). https://doi.org/10.1007/s00132-021-04077-w

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