Skip to main content
Erschienen in: Der Orthopäde 11/2017

27.10.2017 | Arthroskopie | Leitthema

Knorpelregenerative Eingriffe am Hüftgelenk

Was ist machbar?

verfasst von: Prof. Dr. med. Stefan Landgraeber, Marcus Jäger, Stefan Fickert

Erschienen in: Die Orthopädie | Ausgabe 11/2017

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat Beck M, Leunig M, Parvizi J et al (2004) Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res 418:67–73CrossRef Beck M, Leunig M, Parvizi J et al (2004) Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res 418:67–73CrossRef
2.
Zurück zum Zitat Byrd JW, Jones KS (2009) Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clin Orthop Relat Res 467:739–746CrossRefPubMed Byrd JW, Jones KS (2009) Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clin Orthop Relat Res 467:739–746CrossRefPubMed
3.
Zurück zum Zitat Chen H, Sun J, Hoemann CD et al (2009) Drilling and microfracture lead to different bone structure and necrosis during bone-marrow stimulation for cartilage repair. J Orthop Res 27:1432–1438CrossRefPubMed Chen H, Sun J, Hoemann CD et al (2009) Drilling and microfracture lead to different bone structure and necrosis during bone-marrow stimulation for cartilage repair. J Orthop Res 27:1432–1438CrossRefPubMed
4.
Zurück zum Zitat Classen T, Korsmeier K, Kamminga M et al (2016) Is early treatment of cam-type femoroacetabular impingement the key to avoiding associated full thickness isolated chondral defects? Knee Surg Sports Traumatol Arthrosc 24:2332–2337CrossRefPubMed Classen T, Korsmeier K, Kamminga M et al (2016) Is early treatment of cam-type femoroacetabular impingement the key to avoiding associated full thickness isolated chondral defects? Knee Surg Sports Traumatol Arthrosc 24:2332–2337CrossRefPubMed
5.
Zurück zum Zitat Domb BG, Gupta A, Dunne KF et al (2015) Microfracture in the hip: results of a matched-cohort controlled study with 2‑year follow-up. Am J Sports Med 43:1865–1874CrossRefPubMed Domb BG, Gupta A, Dunne KF et al (2015) Microfracture in the hip: results of a matched-cohort controlled study with 2‑year follow-up. Am J Sports Med 43:1865–1874CrossRefPubMed
6.
Zurück zum Zitat Dorn U (1990) Hip screening in newborn infants. Clinical and ultrasound results. Wien Klin Wochenschr Suppl 181:3–22PubMed Dorn U (1990) Hip screening in newborn infants. Clinical and ultrasound results. Wien Klin Wochenschr Suppl 181:3–22PubMed
8.
Zurück zum Zitat Fickert S (2016) Hüftgelenk. In: Fritz J, Albrecht D, Niemeyer P (Hrsg) Praxisleitfaden der AG Klinische Geweberegeneration der DGOU. De Gruyter, Berlin, S 255–266 Fickert S (2016) Hüftgelenk. In: Fritz J, Albrecht D, Niemeyer P (Hrsg) Praxisleitfaden der AG Klinische Geweberegeneration der DGOU. De Gruyter, Berlin, S 255–266
9.
Zurück zum Zitat Fontana A (2012) A novel technique for treating cartilage defects in the hip: a fully arthroscopic approach to using autologous matrix-induced chondrogenesis. Arthrosc Tech 1:e63–68CrossRefPubMedPubMedCentral Fontana A (2012) A novel technique for treating cartilage defects in the hip: a fully arthroscopic approach to using autologous matrix-induced chondrogenesis. Arthrosc Tech 1:e63–68CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Fontana A (2016) Autologous Membrane Induced Chondrogenesis (AMIC) for the treatment of acetabular chondral defect. Muscles Ligaments Tendons J 6:367–371PubMedPubMedCentral Fontana A (2016) Autologous Membrane Induced Chondrogenesis (AMIC) for the treatment of acetabular chondral defect. Muscles Ligaments Tendons J 6:367–371PubMedPubMedCentral
11.
Zurück zum Zitat Fontana A, De Girolamo L (2015) Sustained five-year benefit of autologous matrix-induced chondrogenesis for femoral acetabular impingement-induced chondral lesions compared with microfracture treatment. Bone Joint J 97-B:628–635CrossRefPubMed Fontana A, De Girolamo L (2015) Sustained five-year benefit of autologous matrix-induced chondrogenesis for femoral acetabular impingement-induced chondral lesions compared with microfracture treatment. Bone Joint J 97-B:628–635CrossRefPubMed
12.
Zurück zum Zitat Fontana A, Bistolfi A, Crova M et al (2012) Arthroscopic treatment of hip chondral defects: autologous chondrocyte transplantation versus simple debridement – a pilot study. Arthroscopy 28:322–329CrossRefPubMed Fontana A, Bistolfi A, Crova M et al (2012) Arthroscopic treatment of hip chondral defects: autologous chondrocyte transplantation versus simple debridement – a pilot study. Arthroscopy 28:322–329CrossRefPubMed
13.
Zurück zum Zitat Frisbie DD, Oxford JT, Southwood L et al (2003) Early events in cartilage repair after subchondral bone microfracture. Clin Orthop Relat Res 407:215–227CrossRef Frisbie DD, Oxford JT, Southwood L et al (2003) Early events in cartilage repair after subchondral bone microfracture. Clin Orthop Relat Res 407:215–227CrossRef
14.
Zurück zum Zitat Goyal D, Keyhani S, Lee EH et al (2013) Evidence-based status of microfracture technique: a systematic review of level I and II studies. Arthroscopy 29:1579–1588CrossRefPubMed Goyal D, Keyhani S, Lee EH et al (2013) Evidence-based status of microfracture technique: a systematic review of level I and II studies. Arthroscopy 29:1579–1588CrossRefPubMed
15.
Zurück zum Zitat Green CJ, Beck A, Wood D et al (2016) The biology and clinical evidence of microfracture in hip preservation surgery. J Hip Preserv Surg 3:108–123CrossRefPubMedPubMedCentral Green CJ, Beck A, Wood D et al (2016) The biology and clinical evidence of microfracture in hip preservation surgery. J Hip Preserv Surg 3:108–123CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Harris JD, Erickson BJ, Bush-Joseph CA et al (2013) Treatment of femoroacetabular impingement: a systematic review. Curr Rev Musculoskelet Med 6:207–218CrossRefPubMedPubMedCentral Harris JD, Erickson BJ, Bush-Joseph CA et al (2013) Treatment of femoroacetabular impingement: a systematic review. Curr Rev Musculoskelet Med 6:207–218CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Haviv B, Singh PJ, Takla A et al (2010) Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damage. J Bone Joint Surg Br 92:629–633CrossRefPubMed Haviv B, Singh PJ, Takla A et al (2010) Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damage. J Bone Joint Surg Br 92:629–633CrossRefPubMed
18.
Zurück zum Zitat Hindle P, Hall AC, Biant LC (2014) Viability of chondrocytes seeded onto a collagen I/III membrane for matrix-induced autologous chondrocyte implantation. J Orthop Res 32:1495–1502CrossRefPubMed Hindle P, Hall AC, Biant LC (2014) Viability of chondrocytes seeded onto a collagen I/III membrane for matrix-induced autologous chondrocyte implantation. J Orthop Res 32:1495–1502CrossRefPubMed
19.
Zurück zum Zitat Ilizaliturri VM Jr., Byrd JW, Sampson TG et al (2008) A geographic zone method to describe intra-articular pathology in hip arthroscopy: cadaveric study and preliminary report. Arthroscopy 24:534–539CrossRefPubMed Ilizaliturri VM Jr., Byrd JW, Sampson TG et al (2008) A geographic zone method to describe intra-articular pathology in hip arthroscopy: cadaveric study and preliminary report. Arthroscopy 24:534–539CrossRefPubMed
20.
Zurück zum Zitat Jordan MA, Van Thiel GS, Chahal J et al (2012) Operative treatment of chondral defects in the hip joint: a systematic review. Curr Rev Musculoskelet Med 5:244–253CrossRefPubMedPubMedCentral Jordan MA, Van Thiel GS, Chahal J et al (2012) Operative treatment of chondral defects in the hip joint: a systematic review. Curr Rev Musculoskelet Med 5:244–253CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Kaya M, Suzuki T, Emori M et al (2016) Hip morphology influences the pattern of articular cartilage damage. Knee Surg Sports Traumatol Arthrosc 24:2016–2023CrossRefPubMed Kaya M, Suzuki T, Emori M et al (2016) Hip morphology influences the pattern of articular cartilage damage. Knee Surg Sports Traumatol Arthrosc 24:2016–2023CrossRefPubMed
22.
Zurück zum Zitat Von Keudell A, Atzwanger J, Forstner R et al (2012) Radiological evaluation of cartilage after microfracture treatment: a long-term follow-up study. Eur J Radiol 81:1618–1624CrossRef Von Keudell A, Atzwanger J, Forstner R et al (2012) Radiological evaluation of cartilage after microfracture treatment: a long-term follow-up study. Eur J Radiol 81:1618–1624CrossRef
23.
Zurück zum Zitat Kolb A, Schweiger N, Mailath-Pokorny M et al (2016) Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors. Int Orthop 40:123–127CrossRefPubMed Kolb A, Schweiger N, Mailath-Pokorny M et al (2016) Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors. Int Orthop 40:123–127CrossRefPubMed
25.
26.
Zurück zum Zitat Kuroda R, Ishida K, Matsumoto T et al (2007) Treatment of a full-thickness articular cartilage defect in the femoral condyle of an athlete with autologous bone-marrow stromal cells. Osteoarthr Cartil 15:226–231CrossRefPubMed Kuroda R, Ishida K, Matsumoto T et al (2007) Treatment of a full-thickness articular cartilage defect in the femoral condyle of an athlete with autologous bone-marrow stromal cells. Osteoarthr Cartil 15:226–231CrossRefPubMed
27.
Zurück zum Zitat Kurtz S, Ong K, Lau E et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785PubMed Kurtz S, Ong K, Lau E et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785PubMed
28.
Zurück zum Zitat Landgraeber S, Körsmeier K, Lazik-Palm A et al (2016) Arthroskopische Behandlung von lokalisierten Knorpelschäden an der Hüfte mittels autologer Knorpelzelltransplantation vs. Mikrofrakturierung. DKOU, Berlin Landgraeber S, Körsmeier K, Lazik-Palm A et al (2016) Arthroskopische Behandlung von lokalisierten Knorpelschäden an der Hüfte mittels autologer Knorpelzelltransplantation vs. Mikrofrakturierung. DKOU, Berlin
29.
Zurück zum Zitat Landgraeber S, Warwas S, Lazik-Palm A et al (2017) Behandlung von Osteonekrosen des Hüftkopfes mit Einbruch der subchondralen Lamelle und darüberliegendem Knorpelschaden. DKOU, Berlin Landgraeber S, Warwas S, Lazik-Palm A et al (2017) Behandlung von Osteonekrosen des Hüftkopfes mit Einbruch der subchondralen Lamelle und darüberliegendem Knorpelschaden. DKOU, Berlin
30.
Zurück zum Zitat Li AE, Jawetz ST, Greditzer HGT et al (2016) MRI for the preoperative evaluation of femoroacetabular impingement. Insights Imaging 7:187–198CrossRefPubMed Li AE, Jawetz ST, Greditzer HGT et al (2016) MRI for the preoperative evaluation of femoroacetabular impingement. Insights Imaging 7:187–198CrossRefPubMed
31.
Zurück zum Zitat MacDonald AE, Bedi A, Horner NS et al (2016) Indications and outcomes for microfracture as an adjunct to hip arthroscopy for treatment of chondral defects in patients with femoroacetabular impingement: a systematic review. Arthroscopy 32:190–200.e2CrossRefPubMed MacDonald AE, Bedi A, Horner NS et al (2016) Indications and outcomes for microfracture as an adjunct to hip arthroscopy for treatment of chondral defects in patients with femoroacetabular impingement: a systematic review. Arthroscopy 32:190–200.e2CrossRefPubMed
32.
Zurück zum Zitat Mardones R, Via AG, Jofre C et al (2016) Cell therapy for cartilage defects of the hip. Muscles Ligaments Tendons J 6:361–366PubMedPubMedCentral Mardones R, Via AG, Jofre C et al (2016) Cell therapy for cartilage defects of the hip. Muscles Ligaments Tendons J 6:361–366PubMedPubMedCentral
33.
Zurück zum Zitat Meftah M, Rodriguez JA, Panagopoulos G et al (2011) Long-term results of arthroscopic labral debridement: predictors of outcomes. Orthopedics 34:e588–e592PubMed Meftah M, Rodriguez JA, Panagopoulos G et al (2011) Long-term results of arthroscopic labral debridement: predictors of outcomes. Orthopedics 34:e588–e592PubMed
34.
Zurück zum Zitat Mistry H, Connock M, Pink J et al (2017) Autologous chondrocyte implantation in the knee: systematic review and economic evaluation. Health Technol Assess 21:1–294CrossRef Mistry H, Connock M, Pink J et al (2017) Autologous chondrocyte implantation in the knee: systematic review and economic evaluation. Health Technol Assess 21:1–294CrossRef
35.
Zurück zum Zitat Mithoefer K, Mcadams T, Williams RJ et al (2009) Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 37:2053–2063CrossRefPubMed Mithoefer K, Mcadams T, Williams RJ et al (2009) Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 37:2053–2063CrossRefPubMed
36.
Zurück zum Zitat Philippon MJ, Schenker ML, Briggs KK et al (2008) Can microfracture produce repair tissue in acetabular chondral defects? Arthroscopy 24:46–50CrossRefPubMed Philippon MJ, Schenker ML, Briggs KK et al (2008) Can microfracture produce repair tissue in acetabular chondral defects? Arthroscopy 24:46–50CrossRefPubMed
37.
Zurück zum Zitat Philippon MJ, Briggs KK, Yen YM et al (2009) Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br 91:16–23CrossRefPubMed Philippon MJ, Briggs KK, Yen YM et al (2009) Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br 91:16–23CrossRefPubMed
38.
Zurück zum Zitat Pietschmann MF, Horng A, Niethammer T et al (2009) Cell quality affects clinical outcome after MACI procedure for cartilage injury of the knee. Knee Surg Sports Traumatol Arthrosc 17:1305–1311CrossRefPubMed Pietschmann MF, Horng A, Niethammer T et al (2009) Cell quality affects clinical outcome after MACI procedure for cartilage injury of the knee. Knee Surg Sports Traumatol Arthrosc 17:1305–1311CrossRefPubMed
40.
Zurück zum Zitat Rittmeister M, Hochmuth K, Kriener S et al (2005) Five-year results following autogenous osteochondral transplantation to the femoral head. Orthopäde 34(320):322–326 Rittmeister M, Hochmuth K, Kriener S et al (2005) Five-year results following autogenous osteochondral transplantation to the femoral head. Orthopäde 34(320):322–326
41.
Zurück zum Zitat Stafford GH, Bunn JR, Villar RN (2011) Arthroscopic repair of delaminated acetabular articular cartilage using fibrin adhesive. Results at one to three years. Hip Int 21:744–750CrossRefPubMed Stafford GH, Bunn JR, Villar RN (2011) Arthroscopic repair of delaminated acetabular articular cartilage using fibrin adhesive. Results at one to three years. Hip Int 21:744–750CrossRefPubMed
42.
Zurück zum Zitat Streich NA, Gotterbarm T, Barie A et al (2009) Prognostic value of chondral defects on the outcome after arthroscopic treatment of acetabular labral tears. Knee Surg Sports Traumatol Arthrosc 17:1257–1263CrossRefPubMed Streich NA, Gotterbarm T, Barie A et al (2009) Prognostic value of chondral defects on the outcome after arthroscopic treatment of acetabular labral tears. Knee Surg Sports Traumatol Arthrosc 17:1257–1263CrossRefPubMed
43.
Zurück zum Zitat Tey M, Mas J, Pelfort X et al (2015) Arthroscopic treatment of hip chondral defects with bone marrow stimulation and BST-CarGel. Arthrosc Tech 4:e29–e33CrossRefPubMedPubMedCentral Tey M, Mas J, Pelfort X et al (2015) Arthroscopic treatment of hip chondral defects with bone marrow stimulation and BST-CarGel. Arthrosc Tech 4:e29–e33CrossRefPubMedPubMedCentral
44.
Zurück zum Zitat Thaler M, Biedermann R, Lair J et al (2011) Cost-effectiveness of universal ultrasound screening compared with clinical examination alone in the diagnosis and treatment of neonatal hip dysplasia in Austria. J Bone Joint Surg Br 93:1126–1130CrossRefPubMed Thaler M, Biedermann R, Lair J et al (2011) Cost-effectiveness of universal ultrasound screening compared with clinical examination alone in the diagnosis and treatment of neonatal hip dysplasia in Austria. J Bone Joint Surg Br 93:1126–1130CrossRefPubMed
45.
Zurück zum Zitat Thorey F, Budde S, Ezechieli M et al (2013) Feasibility of arthroscopic placement of autologous matrix-induced chondrogenesis grafts in the cadaver hip joint. Orthop Rev (Pavia) 5:e26CrossRef Thorey F, Budde S, Ezechieli M et al (2013) Feasibility of arthroscopic placement of autologous matrix-induced chondrogenesis grafts in the cadaver hip joint. Orthop Rev (Pavia) 5:e26CrossRef
46.
Zurück zum Zitat Tzaveas AP, Villar RN (2010) Arthroscopic repair of acetabular chondral delamination with fibrin adhesive. Hip Int 20:115–119PubMed Tzaveas AP, Villar RN (2010) Arthroscopic repair of acetabular chondral delamination with fibrin adhesive. Hip Int 20:115–119PubMed
47.
Zurück zum Zitat Umlauf D, Frank S, Pap T et al (2010) Cartilage biology, pathology, and repair. Cell Mol Life Sci 67:4197–4211CrossRefPubMed Umlauf D, Frank S, Pap T et al (2010) Cartilage biology, pathology, and repair. Cell Mol Life Sci 67:4197–4211CrossRefPubMed
48.
Zurück zum Zitat Valera M, Ibanez N, Sancho R et al (2016) Reliability of Tonnis classification in early hip arthritis: a useless reference for hip-preserving surgery. Arch Orthop Trauma Surg 136:27–33CrossRefPubMed Valera M, Ibanez N, Sancho R et al (2016) Reliability of Tonnis classification in early hip arthritis: a useless reference for hip-preserving surgery. Arch Orthop Trauma Surg 136:27–33CrossRefPubMed
49.
Zurück zum Zitat Wakitani S, Nawata M, Tensho K et al (2007) Repair of articular cartilage defects in the patello-femoral joint with autologous bone marrow mesenchymal cell transplantation: three case reports involving nine defects in five knees. J Tissue Eng Regen Med 1:74–79CrossRefPubMed Wakitani S, Nawata M, Tensho K et al (2007) Repair of articular cartilage defects in the patello-femoral joint with autologous bone marrow mesenchymal cell transplantation: three case reports involving nine defects in five knees. J Tissue Eng Regen Med 1:74–79CrossRefPubMed
Metadaten
Titel
Knorpelregenerative Eingriffe am Hüftgelenk
Was ist machbar?
verfasst von
Prof. Dr. med. Stefan Landgraeber
Marcus Jäger
Stefan Fickert
Publikationsdatum
27.10.2017
Verlag
Springer Medizin
Erschienen in
Die Orthopädie / Ausgabe 11/2017
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI
https://doi.org/10.1007/s00132-017-3491-6

Weitere Artikel der Ausgabe 11/2017

Der Orthopäde 11/2017 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.