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Arthroskopische Dekompression des extraartikulären subspinalen Hüftimpingements

Arthroscopic decompression of extra-articular subspinal hip impingement

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Zusammenfassung

Operationsziel

Vollständige arthroskopische Abtragung einer übermäßigen Verknöcherung unter – oder einer Hypertrophie – der Spina iliaca anterior inferior (SIAI) und Entfernung der hypertrophen einklemmenden Kapsel zwischen dem vorderen Schenkelhals und der Spina. Therapie typischer Begleitpathologien (femoroazetabuläres Cam-Impingement, Labrumläsion).

Indikation

Schmerzhafte Beugeeinschränkung des Hüftgelenks durch knöcherne oder weichteilige Einklemmung unter der Spina iliaca anterior inferior.

Kontraindikationen

Keine Schmerzsymptomatik oder Funktionseinschränkung vorhanden trotz radiologischer subspinaler Enge.

Operationstechnik

Lagerung auf dem Extensionstisch, ggf. Arthroskopie des Hüftgelenks und Beseitigung der intraartikulären Pathologie im zentralen und peripheren Kompartiment. Arthroskopische Darstellung der hypertrophen subspinalen Kapsel und Resektion derselben mittels Shaver und Radiofrequenzelektrode. Vollständige Abtragung der übermäßigen subspinalen Verknöcherung oder der hypertrophen Anteile der SIAI mit der Kugelfräse unter arthroskopischer Sicht und Durchleuchtung.

Weiterbehandlung

Frühfunktionelle Weiterbehandlung, Vollbelastung und freie Beweglichkeit; 3 Wochen Ossifikationsprophylaxe und 8 Wochen Sportpause für Lauf- und Sprungsportarten.

Ergebnisse

Zur arthroskopischen SIAI-Dekompression liegen in der Literatur keine vergleichenden Studien sowie mittel- bzw. langfristige Studienergebnisse vor. Aktuell publizierte Fallserien zeigen eine Verbesserung der ermittelten Scorewerte.

Abstract

Objective

Complete arthroscopic decompression of the impinging subspinal soft tissues and resection of the hypertrophic bone formation between the anterior hip capsule and the anterior inferior iliac spine (AIIS) or decompression of a hypertrophic AIIS.

Indications

Painful anterior hip impingement and decreased hip flexion following a hypertrophic osseous subspinal deformation.

Contraindications

No clinical symptoms or decreased anterior hip function despite radiological osseous subspinal hip impingement.

Surgical technique

Hip arthroscopy in supine position on an extension table. Treatment of possible intraarticular hip pathologies in the central or peripheral compartment. Arthroscopic visualization of the hypertrophic impinging soft tissues below the AIIS and decompression using a shaver or radiofrequency device. Complete arthroscopic resection of the hypertrophic AIIS parts and the osseous subspinal deformation using a high speed burr under fluoroscopic control.

Postoperative management

Early functional rehabilitation with full weight-bearing and unlimited hip motion; 3 weeks ossification prophylaxis and 8 weeks of limitation for jumping and running sports activities.

Results

There are no comparative studies or medium- and long-term study results in the literature for arthroscopic AIIS decompression. However, currently published case series show an improvement of the determined scores.

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, DIAKO Bremen, Gröpelinger Heerstr. 406–408, 28239, Bremen, Deutschland

    M. Bohnsack

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  1. M. Bohnsack
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Correspondence to M. Bohnsack.

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M. Bohnsack gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Redaktion

O. Rühmann, Laatzen

Zeichner

R. Himmelhan, Mannheim

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Bohnsack, M. Arthroskopische Dekompression des extraartikulären subspinalen Hüftimpingements. Oper Orthop Traumatol 30, 87–97 (2018). https://doi.org/10.1007/s00064-018-0538-8

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  • DOI: https://doi.org/10.1007/s00064-018-0538-8

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