Luxationen nach Hüftendoprothetik

 

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Zusammenfassung

Luxationen nach Hüftendoprothetik sind eine der häufigsten Komplikationen des Verfahrens. In Registern ist die rezidivierende Hüftgelenkluxation bereits bis zu 30 % Indikation für eine Revisionsoperation. Die Häufigkeit einer Luxation wird durch indikationsspezifische, patientenabhängige und operationsspezifische Risikofaktoren beeinflusst. 50 % der Luxationen ereignen sich in den ersten 3 Monaten, was die hohe Relevanz operationsspezifischer Einflussfaktoren belegt. Die Diagnostik erfolgt fast immer durch ein Computertomogramm, da nur so die 3-dimensionale Komponentenausrichtung zu bestimmen ist. Die dynamische Bildwandleruntersuchung lässt eine vermehrte Translation (reduzierte Weichgewebsspannung) verifizieren und erlaubt eine Funktionsuntersuchung zur Bestimmung des Luxationsmechanismus. Durch eine Klassifikation der Luxation in 5 Typen, unter Berücksichtigung der Implantatstellung, der Suffizienz der pelvitrochantären Muskulatur, des Vorliegens eines Impingements, der Kongruenz zwischen Kopf und Pfanne sowie der Kombination dieser Faktoren ist eine adäquate Therapieplanung möglich. Therapeutisch hat die korrekte Ausrichtung von Schaft und Pfanne die herausragende Bedeutung. Zusätzlich kann durch die Verwendung größerer Kopfdurchmesser bis hin zu tripolaren Pfannen, die Rekonstruktion der Weichteile und nicht zuletzt durch eine adäquate postoperative Ruhigstellung der Therapieerfolg erreicht werden. Dennoch bleibt festzustellen, dass es sich um eine komplikationsträchtige Behandlung handelt, bei der in der Literatur bis zu ⅓ Fehlschläge, d. h. das Wiederauftreten einer Luxation, angegeben sind.

Abstract

Dislocations after total hip arthroplasties are one of the most common complications of the procedure. According to registers, recurrent hip dislocations account for up to 30 % of the indications for a revision operation. The incidence of a dislocation is influenced by indication-associated, patient-dependent and operation-specific risk factors. 50 % of the dislocations occur within the first 3 months which confirms the high relevance of operation-specific influencing factors. The diagnosis is almost always made with the help of computed tomography, as this is the only method to determine the three-dimensional relationship of the components. A dynamic fluoroscopic examination can verify an increased translation (reduced soft-tissue tension) and thus enables a functional examination to determine the mechanism of the dislocation. By means of a classification of dislocations into five types under consideration of the implant position, the sufficiency of the pelvitrochantar musculature, the presence of an impingement, the congruence of head and acetabular liner as well as combinations of these factors it is possible to plan an adequate therapy. From the therapeutic point of view the correct positioning of the stem and head is of decisive importance. In addition therapeutic success can be realized by using larger head diameters through to tripolar sockets, reconstruction of soft tissues and, last but not least, an adequate postoperative immobilization. Even so, this treatment is associated with a high rate of complications and in the literature failure rates of up to one third, i.e., the reoccurrence of a dislocation, are reported.

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Prof. Dr. Carsten Perka

Centrum für Muskuloskeletale Chirurgie
Klinik für Orthopädie

Charitéplatz 1

10117 Berlin

Email: carsten.perka@charite.de

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