Periprothetische Azetabulumfrakturen

 

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Zusammenfassung

Bei den periprothetischen Azetabulumfrakturen (PpAcFx) handelt es sich – im Gegensatz zu den relativ häufigen periprothetischen Femurfrakturen – um eine seltene Komplikation sowohl in der Primär- als auch in der Revisionsendoprothetik. In der Literatur ist die Thematik bisher unterrepräsentiert, eher durch Einzelfallbeschreibungen geprägt und durch das Fehlen von Langzeitergebnissen gekennzeichnet. Aufgrund der steigenden Lebenserwartung samt zunehmendem Aktivitätsniveau der Patienten wie auch einer ansteigenden Anzahl an primären Hüftprothesenimplantationen ist sowohl mit einem Anstieg periprothetischer Komplikationen im Allgemeinen als auch einer zunehmenden Inzidenz von PpAcFx zu rechnen. Dieser Frakturtyp kann intra- und perioperativ sowie traumatisch oder schleichend postoperativ auftreten. Intraoperativ ist dies meist beim Einbringen einer zementfreien Pfanne oder im Rahmen azetabulärer Revisionschirurgie der Fall. Postoperativ schleichende PpAcFx entstehen z. B. aufgrund von PE-verschleißbedingten Osteolysen. Des Weiteren ist das akute Trauma ursächlich für postoperative PpAcFx. Eine weitere Rolle spielen Frakturen, die intraoperativ nicht erkannt wurden und im weiteren Verlauf sozusagen zu einer Insuffizienzfraktur führen. Die Therapie von PpAcFx ist bei stabiler Pfanne ohne Frakturdislokation konservativ möglich, jedoch im operativen Fall bei einer Vielzahl an möglichen chirurgischen Techniken und teilweise anspruchsvollen Zugangswegen herausfordernd und bedarf daher der Behandlung durch ein Team mit Erfahrung sowohl in der Azetabulumchirurgie als auch in der Wechselendoprothetik unter Berücksichtigung patienten-, fraktur und prothesenspezifischer Faktoren.

Abstract

In contrast to periprosthetic fractures of the femur, periprosthetic fractures of the acetabulum are rare complications – both primary fractures and fractures in revision surgery. This topic is largely under-reported in the literature; there are a few case reports and no long term results. Due to an increase in life expectancy, the level of patientsʼ activity and the number of primary joint replacements, one has to expect a rise in periprosthetic complications in general and periprosthetic acetabular fractures in particular. This kind of fracture can be intra-, peri- or postoperative. Intraoperative fractures are especially associated with insertion of cementless press-fit acetabular components or revision surgery. Postoperative periprosthetic fractures of the acetabulum are usually related to osteolysis, for example, due to polyethylene wear. There are also traumatic fractures and fractures missed intraoperatively that lead to some kind of insufficiency fracture. Periprosthetic fractures of the acetabulum are treated conservatively if the implant is stable and the fracture is not dislocated. If surgery is needed, there are many possible different surgical techniques and challenging approaches. That is why periprosthetic fractures of the acetabulum should be treated by experts in pelvic surgery as well as revision arthroplasty and the features specific to the patient, fracture and prosthetic must always be considered.

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