Hüftgelenkersatz im Kindes-, Jugend- und frühen Erwachsenenalter: Eine Literaturübersicht

 

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Zusammenfassung

Fragestellung: Welche Implantate und Verankerungstechniken eignen sich für den endoprothetischen Hüftgelenkersatz im Kindes-, Jugend- und frühen Erwachsenenalter? Methodik: Die vorliegende Übersichtsarbeit stellt die wichtigsten Daten zum endoprothetischen Hüftgelenkersatz bei jungen Patienten anhand einer „MedLine”-Literaturrecherche über drei Jahrzehnte dar. Als Stichwörter für die Recherche dienten die Suchbegriffe „young patient”, „children”, „adolescents”, „hip arthroplasty”, „total hip replacement” und „hip endoprosthesis”. Hierbei werden die Ergebnisse unter Berü cksichtigung der zur Indikation führenden, vorbestehenden Krankheitsbildern, verwendeten Implantaten sowie die verschiedenen Operationstechniken miteinander verglichen und kritisch diskutiert. Ergebnisse: Während einige Autoren weiterhin eine zementierte Verankerungstechnik sowohl für die Pfannen- als auch fü r die Schaftkomponente beim Hüftgelenkersatz junger Patienten empfehlen, belegt die Mehrzahl aktueller Studienergebnisse die Effektivität einer zementfreien Verankerung. Bei der Entscheidung für ein geeignetes Implantat müssen Vorerkrankungen, Aktivitätsniveau, anatomische Besonderheiten und die Erwartungshaltung der Patienten berücksichtigt werden. Die Mehrzahl der publizierten Studien untersucht ein inhomogenes Patientengut mit verschiedenen Implantaten und zahlreichen Variablen. Hierdurch können diese nur bedingt für eine zuverlässige Aussage zum Outcome von Hüfttotalendoprothesen beim jungen Patienten herangezogen werden. Schlussfolgerungen: Die zementfreie Verankerung von Hüfttotalendoprothesen eignet sich für die Behandlung von jungen Patienten. Es existieren nur wenige evidente Daten zum Outcome eines Prothesen-Typs bei einem definierten Krankheitsbild.

Abstract

Aim: Which implants and fixation techniques should be recommended in total hip replacements in children, adolescents and young adults? Methods: A literature survey served to elucidate the results of recent papers in total hip arthroplasty (THA) over the last three decades. For this literature review the following items were used for a MedLine inquiry: “young patient”, “children”, “adolescents”, “hip arthroplasty”, “total hip replacement” and “hip endoprosthesis”. Different disorders, implant types and surgical techniques were compared and discussed. Results: Although some authors still favor a cementing fixation technique forÂ’acetabular shell and stem components in total hip replacements for young patients, most results of the present studies show the effectiveness of cementless fixation techniques. The indication for or against an implant should be include the preexisting diseases, daily activity, abnormal anatomic findings and consider the patient's expectations. Most studies investigated inhomogeneous probands treated with different implant types and are therefore of only limited appropriateness for reliable conclusions. Conclusions: Cementless fixation in THA is a sufficient technique in total hip replacement in young patients. There are only few data available in the literature dealing with the outcome of one implant type within a defined clinical picture.

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Dr. med. Marcus Jäger

Orthopädische Universitätsklinik Düsseldorf

Moorenstr. 5

40225 Düsseldorf

Phone: 02 11/81-1 79 61

Fax: 02 11/81-1 62 81

Email: Jaeger@med.uni-duesseldorf.de