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Zentralbl Chir 2007; 132(6): 547-553
DOI: 10.1055/s-2007-981362
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© Georg Thieme Verlag Stuttgart · New York

Der Einsatz einer modularen Hüftprothese (MHP) mit distaler Verriegelungsmöglichkeit bei Knochendefektsituationen des Femurs

Treatment of Femoral Bony Defects with a Modular Hip Prosthesis and Distal InterlockingH.-J. Andress1 , K. Junghans1 , C. Schinkel2 , G. Lob2
  • 1Zentrum für Unfallchirurgie und Orthopädie, Klinik München Perlach der Pasing und Perlach GmbH, München
  • 2Unfallchirurgie der Chirurgischen Klinik und Poliklinik der Ludwig-Maximilians Universität München, Klinikum Großhadern, München
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Publication History

Publication Date:
20 December 2007 (online)

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Zusammenfassung

Knochendefekte des proximalen Femurs nach trochantären Frakturen, Implantatversagen von Osteosynthesen („Cut-out”), periprothetischen Frakturen und Prothesenlockerungen stellen erschwerte Bedingungen für die Implantation oder den Wechsel einer Hüftprothese dar. Der Einsatz modularer Hüftprothesen (MHP) mit langem Schaftanteil und der Möglichkeit von distalen Verriegelungsschrauben stellt eine Lösungsmöglichkeit für diese Problemfälle dar. Im Zeitraum vom 1.1.1996 bis 11.1.2002 wurden alle Patienten mit proximalen Knochendefekten und Frakturen, die mit einer MHP versorgt wurden, prospektiv erfasst. Die Nachuntersuchung im Durchschnitt nach 11,4 Monaten erfolgte klinisch und radiologisch. Ermittelt wurde die Veränderung eines modifizierten Harris-Hüft-Scores und radiologische Lockerungszeichen (paraprothetische Begleitlinie, Prothesenmigration, Verriegelungsbolzenbruch). 106 Patienten mit einer Nachuntersuchungsquote von 58,5 % konnten in die Studie eingeschlossen werden. Sowohl die klinischen als auch radiologischen Ergebnisse nach primärer oder sekundärer Implantation bei trochantären Femurfrakturen waren gut, nur eine MHP war gelockert. Der Harris-Hüft-Score veränderte sich nicht signifikant im Vergleich zur Situation vor der Fraktur. Bei Patienten mit Prothesenwechsel auf die MHP waren allerdings fast 25 % der MHP gelockert, z. T. mit Bruch der Verriegelungsschraube. Die distale Schraubenverriegelung einer MHP kann im Rahmen von primären oder sekundären Versorgungen trochantärer Femurfrakturen genügend Stabilität für eine Osseointegration bieten, bei Prothesenwechsel oder periprothetischen Frakturen bietet sie allerdings nur eine ungenügende Stabilisierungsmöglichkeit.

Abstract

Patients with bony defects of the proximal femur after trochanteric fracture, implant failure (cut-out), periprosthetic fracture or aseptic loosening of prosthesis are difficult to treat with primary or revision endoprosthesis. Modular femoral hip prosthesis (MHP) with stems of different length and the possibility of distal interlocking screws are an operative solution for those patients. In a prospective study from January 1996 to January 2002 all patients treated with a MHP because of proximal and / or distal femoral bony defect or fracture were included. Follow-up after 6 to 30 months was evaluated clinically and radiologically in hospital. Change of modified Harris Hip Score and radiological signes of loosening (radiolucent line, migration of MHP, breaking interlocking screw) were documented. 106 patients with a follow-up of 58.5 % were included in the study. At time of follow-up clinical and radiological outcome after trochanteric fracture was good. Harris Hip Score was comparable to the situation of patients before fracture, only one MHP was loose. However in patients after revision arthroplasty 25 % of MHP were loose and in many patients the interlocking screw was broken. Distal interlocking screw in MHP prevents stability after trochanteric fracture to achieve osseointegration. However in case of periprosthetic fracture or revision arthroplasty MHP shows insufficient stability in many cases.

Schlüsselwörter

Femurknochendefekt - modulare Hüftprothese - distale Verriegelung

Key words

femoral bony defect - modular hip prosthesis - distal interlocking

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PD Dr. H.-J. Andress

Zentrum für Unfallchirurgie und Orthopädie · Klinik München Perlach der Pasing und Perlach GmbH

Schmidbauerstr. 44

81737 München

Phone: 0 89 / 67 80 22 22

Fax: 0 89 / 67 80 23 99

Email: pd.andress@kkh-perlach.de

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