Hüftendoprothetik bei gesteigerter Erwartungshaltung

Zusammenfassung

Die Anspruchs- und Erwartungshaltung des Patienten nach Implantation einer Hüftgelenkendoprothese ist deutlich gestiegen. Insbesondere der sportliche Funktionsanspruch steht im Fokus des Patienteninteresses, wobei nicht die grundsätzliche Sportfähigkeit erfragt wird, sondern auch das erreichbare Sportniveau. Die Vorteile einer erhöhten Aktivität mit einer Reduktion der kardiovaskulären Mortalität und der Minimierung des Osteoporoserisikos stehen dem erhöhten Abrieb mit konsekutiver Prothesenlockerung gegenüber. Aktivitäten werden kategorisiert in „low“-, „intermediate“- und „high-impact“-Sportarten. Weitere patientenspezifische Einflussfaktoren, wie die präoperative Konstitution und Expertise, aber auch der Eigenbezug des Operateurs zur gewünschten Sportart, beeinflussen die Empfehlung und Beratung. Innovationen in Prothesendesign und die tribologischen Eigenschaften der Gleitpaarungskomponenten zielen zudem auf eine verbesserte Rückkehr zum Sport. Nach Implantation von Hüftendoprothesen findet die Mehrheit der präoperativ aktiven Patienten zurück zur sportlichen Aktivität, wenn auch eine Tendenz zur Verschiebung von „high-impact“- zu „low-impact“-Sportarten zur verzeichnen ist. Zu den derzeitig empfohlenen Sportarten zählen Schwimmen, Radfahren, Nordic Walking, Segeln, Golf, Wandern, Tanzen und Skilanglauf. Eine eingeschränkte Empfehlung besteht für Tennis, Ski alpin, Bergwandern und sportliches Laufen. Nicht empfohlen hingegen werden Marathon, Fußball, Handball, Volleyball, Basketball, Kampfsport, Weit- und Hochsprung, Wasserski und Felsklettern. Die Empfehlungen beruhen vorwiegend auf Expertenmeinungen und befinden sich in einem progredienten Wandel mit einer Ausdehnung hin zu „high-impact“-Sportarten. Eine gute wissenschaftliche Fundierung liegt nur bedingt vor.

Schlüsselwörter

Sport nach Hüftendoprothese - Abrieb - Impact - Gelenkbelastung

Publication History

Article published online:
19 November 2019

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