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Operative Techniken zur azetabulären Rekonstruktion

  • Chapter
Revisionsendoprothetik der Hüftpfanne

Auszug

Die Anzahl an notwendigen Revisions-und Wechseloperationen nach Hüfttotalendoprothesen steigt kontinuierlich (◘ Abb. 4.1) [1, 2]. Nicht verhindern lässt sich der damit verbundene Knochenverlust im Azetabulum und am Femur [3]. Die Wiederherstellung von anatomisch knöchernen Verhältnissen und biomechanisch korrekter Implantatlage ist eine große Herausforderung, die auf unterschiedliche Weise angegangen werden kann. Für die Revision des Azetabulums wurden z. B. große zementfreie Pfannen (sog. Jumbo-Pfannen), Revisionsringe, Stützschalen und schlussendlich auch Keramiktransplantate verwendet. Diese Methoden stellen zwar die Biomechanik wieder her, führen aber nicht zum Wiederherstellen des Knochenlagers. Andere Methoden, wie z. B. Medialisierung der Pfanne oder Implantation in einem höheren Hüftzentrum, konfigurieren eine Situation, die nicht der normalen Biomechanik entspricht. Alternativ können Knochendefekte durch modulare poröse Metallaugmentationen überbrückt werden. Als Hauptziel bei der Hüfttotalendoprothesenrevisionsoperation sollte neben dem Wiederherstellen der biomechanischen Physiologie immer auch die Wiederherstellung des Knochenlagers im Vordergrund stehen, um im Falle einer weiteren Revision wieder anatomische knöcherne Verhältnisse vorzufinden, die eine neuerliche Implantation ermöglichen. Dieses Kapitel behandelt den Einsatz von Allografts aus der Knochenbank zum Erreichen dieses Ziels.

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Authors and Affiliations

  1. Klinik für Unfall-und Wiederherstellungs chirurgie, Klinikum Stuttgart Katharinenhospital, Kriegsbergstr. 60, 70174, Stuttgart, Deutschland

    PD Dr. Paul Alfred Grützner

  2. Orthopädische Klinik und Poliklinik, Universität Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland

    Prof. Dr. Wolfram Mittelmeier

  3. Campus Charité Mitte, Zentrum für Muskuloskletale Chirurgie, Schumannstr. 20/21, 10117, Berlin, Deutschland

    Prof. Dr. Carsten Perka

  4. Abt. Unfallchirurgie, Endoprothetik, Schulter und Handchirurgie, Krankenhaus Rummelsberg, Rummelsberg 71, 90592, Schwarzenbruck, Deutschland

    Prof. Dr. Richard Stangl

  5. Klinik für Orthopädie, Klinikum Frankfurt/Oder, Müllroser Chaussee 7, 15236, Frankfurt/Oder, Deutschland

    Dr. Klemens Trieb

  6. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Siegmund-Freud-Str. 25, 53127, Bonn, Deutschland

    Prof. Dr. D. C. Wirtz

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  1. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Siegmund-Freud-Str.25, 53127, Bonn

    Dieter C. Wirtz

  2. St.Franziskus-Hospital Köln Orthopädie, Schönsteinstr.63, 50825, Köln

    Christof Rader

  3. Orthopädische Universitätsklinik am RKU, Oberer Eselsberg 45, 89081, Ulm

    Heiko Reichel

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Bader, R. et al. (2008). Operative Techniken zur azetabulären Rekonstruktion. In: Wirtz, D.C., Rader, C., Reichel, H. (eds) Revisionsendoprothetik der Hüftpfanne. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-75649-1_4

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