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Periprothetische Frakturen bei Hüftendoprothese

Klassifikation, Diagnostik und Therapiestrategien

Periprosthetic fractures after total hip arthroplasty

Classification, diagnosis and therapy strategies

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Zusammenfassung

Die Inzidenz periprothetischer Frakturen nach Hüftgelenkendoprothetik nimmt aufgrund erhöhter Lebenserwartung und steigender Implantationszahlen kontinuierlich zu. Ursächlich können reine Traumen, implantatspezifische Faktoren und Prothesenlockerungen sein. Bei der Therapieplanung müssen zudem spezifische Patientenparameter sowie allgemeine Risikofaktoren bedacht werden, um eine bestmögliche Versorgung zu gewährleisten. Im Rahmen der präoperativen Diagnostik können etablierte Klassifikationssysteme hilfreich sein. Zurzeit wird die Vancouver-Klassifikation am häufigsten verwendet, da sie die Lokalisation der Fraktur, die Stabilität des Implantats und die Knochenqualität berücksichtigt. Abhängig von diesen Faktoren reichen die Therapieoptionen vom konservativen Vorgehen über die operative Frakturstabilisierung bis hin zum Prothesenwechsel. Unter Berücksichtigung etablierter Klassifikationssysteme werden die Probleme der periprothetischen Frakturen verschiedener Ausgangssituationen dargestellt und die verfügbaren Versorgungsmöglichkeiten diskutiert.

Abstract

The number of periprosthetic fractures following hip replacement is increasing due to longer life expectancy and the rising number of joint replacements. The main causes of periprosthetic fractures include trauma, implant specific factors or loosening of the endoprosthesis. When planning therapy, surgeons should consider specific and general implant- and patient-related risk factors to ensure the best possible treatment. Established classification systems can facilitate preoperative planning. At present, the Vancouver classification system probably comes closest to the ideal, as it considers fracture configuration, stability of the implant and quality of the bone stock. Depending on these factors, therapeutic options include conservative treatment, fracture stabilisation or replacement of the endoprosthesis. The problems associated with periprosthetic fractures of varying etiology and the available treatment options are discussed against the background of the established classification systems.

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Authors and Affiliations

  1. Orthopädische Klinik König-Ludwig-Haus, Julius-Maximilians-Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland

    B.M. Holzapfel, M. Hoberg & M. Rudert

  2. Klinik und Poliklinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland

    B.M. Holzapfel & R. Meffert

  3. Klinik für Orthopädie und Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland

    P.M. Prodinger & R. Gradinger

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  1. B.M. Holzapfel
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  2. P.M. Prodinger
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  3. M. Hoberg
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  4. R. Meffert
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  6. R. Gradinger
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Correspondence to B.M. Holzapfel.

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Holzapfel, B., Prodinger, P., Hoberg, M. et al. Periprothetische Frakturen bei Hüftendoprothese. Orthopäde 39, 519–535 (2010). https://doi.org/10.1007/s00132-010-1612-6

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