Hüftendoprothetik nach Osteotomien des Beckens und des proximalen Femurs

Hip arthroplasty after pelvic and femoral osteotomies

Zusammenfassung

Osteotomien am Becken oder am Femur stellen auch erfahrene Endoprothetiker vor eine Herausforderung. In einigen Fällen kann verbliebenes Metall das Einsetzen der Endoprothese erschweren. Nicht selten können auch anatomische Abweichungen vorliegen, die die Implantation einer Endoprothese verkomplizieren. Abhängig von der Voroperation können diese Abweichungen sehr unterschiedlich aussehen. An der Pfanne kann dies den Einsatz eines Revisionssystems für die Primärimplantation erfordern. Am Schaft kann eine zusätzliche Korrekturosteotomie notwendig werden. In jedem Fall ist eine genaue präoperative Planung erforderlich und eine präoperatives CT mit 3‑D-Rekonstruktion ist ein sehr nützliches Instrument, um Besonderheiten, die nicht zwingend aus der konventionellen Bildgebung hervorgehen, präoperativ erkennen zu können.

Abstract

Pelvic and femoral osteotomies can be a challenge even for experienced orthopedic surgeons. Residual metal may complicate the insertion of the endoprosthesis in some cases. Sometimes, the anatomical modification of the previous osteotomy complicates the total hip replacement. This may require the use of an acetabular revision system for the primary implantation. Femoral deformities can require additional osteotomies of the femur during the implantation. In every case, accurate preoperative planning should be performed. A preoperative CT with 3D reconstruction is a powerful tool for further information beyond conventional imaging.

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Abbreviations

BO:

Beckenosteotomie

CT:

Computertomographie

ERAO:

„Eccentric Rotational Acetabular Osteotomy“

HHS:

Harris Hip Score

ITO:

Intertrochantäre Osteotomie

PAO:

Periazetabuläre Osteotomie

RAO:

„Rotational Acetabular Osteotomy“

TEP:

Totalendoprothese

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Correspondence to Dr. A. R. Zahedi.

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A.R. Zahedi und C. Lüring geben an, dass kein Interessenkonflikt besteht.

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

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Zahedi, A.R., Lüring, C. Hüftendoprothetik nach Osteotomien des Beckens und des proximalen Femurs. Orthopäde 48, 308–314 (2019). https://doi.org/10.1007/s00132-019-03693-x

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Schlüsselwörter

  • Azetabulum
  • 3D-Computertomographie
  • Hüftdysplasie
  • Morbus Perthes
  • Hüfttotalendoprothese

Keywords

  • Acetabulum
  • Computer-generated 3D imaging
  • Hip dysplasia
  • Legg-Calve-Perthes disease
  • Total hip replacement