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Aktuelle Rheumatologie 2018; 43(01): 60-72
DOI: 10.1055/s-0042-118698
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Komplikationen in der Hüftchirurgie beim Rheumatiker

Complications of Hip Surgery in Rheumatic Patients
Ludwig Bause
1   St-Josef-Stift, Orthopädische Rheumatologie, Sendenhorst
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Publication History

Publication Date:
05 March 2018 (online)

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Zusammenfassung

Die Erfolge der modernen Hüftendoprothetik sind unbestritten und ermöglichen vielen Patienten eine weiterhin aktive Lebensgestaltung. Gerade Patienten mit rheumatischer Grunderkrankung, die verhältnismäßig häufiger und in jüngerem Lebensalter betroffen sind, profitieren hiervon. Obwohl die technische Durchführung der Endoprothetik hierbei ähnlichen Gesetzen unterliegt wie bei arthrotischer Grunderkrankung sind doch krankheitsspezifische Besonderheiten zu beachten. Aus dem Blickwinkel einer auf Rheumachirurgie spezialisierten Klinik werden Besonderheiten der Endoprothetik rheumatischer Hüften anhand eigener Erfahrungen und der Literatur diskutiert. Hierbei wird sowohl auf die Primärversorgung als auch die Revisionschirurgie eingegangen. Revisionsgründe wie aseptische und septische Lockerungen, Luxationen, Materialversagen und periprothetische Frakturen werden erläutert. Besonders betrachtet wird die z. T. schwierige Differenzialdiagnose zwischen septischen und aseptischen Lockerungen. Im Rahmen einer Schubsituation der Grunderkrankung und gleichzeitiger Immunsuppression kann die Abgrenzung zu einem periprothetischen Infekt schwierig sein. Hier ist aufgrund der rasch ansteigenden Komplikationsrate besonders bei multilokulären Infekten eine schnelle Differenzierung und schnelle adäquate Therapieeinleitung erforderlich.

Abstract

There is broad consensus that the success in modern total hip arthroplasty has substantially contributed to the quality of life in many patients, with obvious benefits in younger patients suffering from rheumatic disease, who require more frequent and earlier intervention in their lives. Although the technique of total hip arthroplasty is similar to the procedure used in patients with primary osteoarthritis, specific features of rheumatic hip disease have to be considered. These disease characteristics are discussed from the perspective of a clinic specialised in rheumatic surgery based on their own experience and published data. The discussion includes primary care as well as revision surgery and explains causes for revisions such as aseptic and septic loosening, dislocation, material failure and periprosthetic fractures. Special consideration is given to the differential diagnosis between septic and aseptic loosening, which may be difficult to distinguish from each other. During a flare and with concurrent immunosuppression, it may be difficult to differentiate between the clinical appearance of the rheumatic disease and a periprosthetic infection. As the latter is associated with a rapidly increasing rate of complications, especially in the case of multilocular infections, the diagnosis must be made quickly and adequate treatment should be initiated without delay.

Schlüsselwörter

rheumatoide Arthritis - Hüftendoprothese - perioperatives Management - periprothetische Infektion - periprothetische Fraktur

Key words

rheumatoid arthritis - hip prosthesis - perioperative management - periprosthetic infection - periprosthetic fractures
 

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