Metaphysär verankernde, zementfreie Kurzschaftprothese – klinisch-radiologische Ergebnisse einer prospektiven Single-Surgeon-Studie

Zusammenfassung

Fragestellung: Der Einsatz von Kurzschaftprothesen gewinnt als geeignete Alternative zur konventionellen „stielverankernden“ Totalendoprothese beim jungen und aktiven Patienten in der Behandlung der Koxarthrose zunehmend an Bedeutung. Propagierte Vorteile des Verfahrens sind die knochen- und schenkelhalserhaltende Implantation bei nahezu physiologischer Krafteinleitung in das proximale Femur. In diesem Zusammenhang präsentieren wir erste klinische und nativradiologische Ergebnisse der AIDA®-Kurzschaftprothese im Rahmen einer Single-Surgeon-Studie. Methodik: Bei der Studie handelt es sich um eine prospektive, klinische Multicenterstudie. Die Studie wurde von der Ethikkommission genehmigt. Das dargestellte Patientenkollektiv entstammt einem an der Multicenterstudie beteiligten Studiencenter. Implantiert wurden von Februar 2009 bis Dezember 2013 72 AIDA®-Kurzschaftprothesen (Fa. Implantcast) bei 71 Patienten bei definierter Indikationsstellung bei Koxarthrose. Alle Operationen wurden von 1 Operateur durchgeführt („single surgeon study“). 51 Patienten mit 52 Prothesen (Lebensalter 61 ± 3,2 Jahre [min.–max. 46–68 Jahre]; 35 weiblich; 16 männlich) mit einer Standzeit > 2 Jahre wurden klinisch und nativradiologisch ausgewertet. Die Patienten wurden prä- und postoperativ im Rahmen eines festgelegten Studienprotokolls klinisch und nativradiologisch untersucht. Ergebnisse: Die klinischen Nachuntersuchungsergebnisse zeigen deutlich verbesserte funktionelle Ergebnisse postoperativ. Der Harris-Hip-Score stieg signifikant von präoperativ 41,4 ± 4,5 auf postoperativ 96,8 ± 3,2 Punkte zum Zeitpunkt der letzten Zwischenauswertung. Der stationäre Aufenthalt betrug im Mittelwert 9,1 ± 1,2 Tage. Die nativradiologische Nachuntersuchung zeigte in allen Fällen einen festen Sitz des Kurzschafts ohne Lockerung, Migration und Resorptionssäume. Operationsspezifische Komplikationen wurden nicht beobachtet. Postoperativ kam es zu einer periprothetischen Femurschaftfraktur (Revisionsrate 1,9 %). Hier erfolgte die komplikationslose Revision auf einen zementfreien Geradschaft. Schlussfolgerung: Die AIDA-Kurzschaftprothese stellt unter strenger Indikationsstellung ein vielversprechendes Verfahren zur operativen Behandlung der Koxarthrose dar. Die kurzfristigen klinischen Ergebnisse sind ermutigend, langfristige Ergebnisse gilt es abzuwarten.

Abstract

Background: Conventional uncemented femoral stems provide good long-term fixation in patients with a wide range of clinical function. However, preservation of bone stock, and minimally invasive approaches have led to exploration into various other implant designs. Short-stem prosthesis focusing on a stable metaphyseal fit have emerged to address these challenges in total hip arthroplasty. The purpose of this study was to evaluate the clinical and radiological results of a newly developed short-stem hip prosthesis AIDA® in context of a single surgeon study. Material and Methods: From February 2009 to December 2013, 72 cementless “AIDA® short stems” (Fa. Implantcast) were implanted by a single surgeon in one study centre via the Watson Jones interval. All patients signed informed consent prior to screening and the study design was approved by the local ethics committee. 51 patients with 52 implants (35 female, 36 male) with a follow-up > 24 months were included in this prospective, controlled clinical trial. The patients were pre- and postoperatively examined clinically and radiological by a specified protocol. Results: The average patient age at the time of THA was 61 ± 3.2 years (min.–max. 46–68 years). At the last follow-up, the average Harris Hip score increased from 41.4 ± 4.5 preoperatively to 96.8 ± 3.2 points postoperatively. The hospital stay was 9.1 days on average. The X-rays showed in all cases a stable fixation of the stems with full bony integration and no signs of loosening or migration. There were no specific complications relating to the less invasive approach. Postoperatively one periprosthetic fracture was evident. The revision operation into a cementless stem was done without any complications (revisions rate 1.9 %). Conclusion: The newly developed “AIDA short stem” is a promising hip implant for the young and active patient with osteoarthritis of the hip. The short-term results are encouraging, but nevertheless mid- and long-term results must be further observed on a prospective basis as part of this collective study.

Schlüsselwörter

Kurzschaftprothese - primärer Hüftgelenkersatz - klinische Ergebnisse - knochenerhaltend

Key words

short-stem prothesis - primary hip arthroplasty - clinical results - bone preserving

^* Beide Autoren haben zu gleichen Teilen zur Entstehung dieser Arbeit beigetragen.

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