Patientenindividuelle Rekonstruktion der Biomechanik in der Hüftendoprothetik

Zusammenfassung

Eine exakte Rekonstruktion der Biomechanik ist ein wesentlicher Bestandteil in der Hüftendoprothetik für eine gute postoperative Beweglichkeit und Stabilität des Kunstgelenks. Die präoperative Planung des Beinlängen- und Offsetausgleichs wird üblicherweise auf größenskalierten konventionellen Röntgenbildern durchgeführt, die jedoch durch die zweidimensionale Projektion der Gefahr von Fehlberechnungen unterliegen. Insbesondere das femorale Offset wird dabei häufig unterschätzt. Bei der Rekonstruktionsgenauigkeit von Beinlänge und Offset sollten Unterschiede von über 1 cm postoperativ vermieden werden. Analysen der Gangkinematik zeigen jedoch bereits Veränderungen im Gangmuster bei Beinlängen- und Offsetunterschieden von über 5 mm. Neben einer Vielzahl anderer Methoden eignen sich zur intraoperativen Umsetzung der Beinlängen- und Offsetrekonstruktion sowohl die bildfreie Navigation als auch die Fluoroskopie. Eine Abschätzung der Schafttorsion der einliegenden Endoprothese ist neben des Goldstandards CT auch auf konventionellen Röntgenaufnahmen mithilfe der Bestimmung des projizierten CCD-Winkels möglich. Als prädiktiver Parameter eignet sich die Isthmus-Ratio (iRatio), um bereits präoperativ nativradiologisch einen Hinweis der intraoperativ zu erwartenden Schafttorsion zu erhalten. Die Größe des Trochanter minor hilft, eine Abschätzung der nativen Torsion des Femurs treffen zu können.

Schlüsselwörter

biomechanische Rekonstruktion - Beinlänge - Offset - Planung - Hüftendoprothetik

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