Inzidenz von anterioren intertrochantären Ossifikationen bei Hüfttotalendoprothesen – eine retrospektive Langzeituntersuchung

Zusammenfassung

Ziel: Die retrospektive Studie untersucht das Auftreten von anterioren intertrochantären Ossifikationen (AIO) im Langzeitverlauf, speziell im Vergleich mit heterotopen Ossifikationen in der a.–p. Ebene (Klassifikation nach Brooker). Weiters wird ein Kontext zwischen Ossifikationen und klinischem Bild (HHS, ROM) hergestellt. Material und Methoden: 149 zementfreie Hüfttotalendoprothesen (Hofer-Imhof-Schraubpfanne, Geradschäfte), implantiert in 140 Patienten von November 1991 bis Dezember 1994, konnten von Dezember 2005 bis Oktober 2006 einer klinisch-radiologischen Nachuntersuchung unterzogen werden. Unter den 81 weiblichen und 59 männlichen Patienten betrug das durchschnittliche Lebensalter bei Implantation 64 Jahre. In sämtlichen Fällen wurde über den transglutealen Zugang nach Bauer instrumentiert. Die aktuellen Röntgenbilder wurden manuell vermessen und mit Vorbildern verglichen. Ergebnisse: In 77 Fällen (51,7 %) fanden sich AIO, in 93 Fällen (62,4 %) heterotope Ossifikationen in der a.–p. Ebene (Brooker), AIO und Brooker kombiniert in 58 Fällen (38,9 %), AIO alleine in 19 Fällen (12,8 %). Weder HHS noch ROM waren durch die Ossifikationen signifikant beeinflusst, sämtliche Ossifikationen blieben nach dem ersten postoperativen Jahr radiologisch stationär. Schlussfolgerung: Die Anfertigung axialer Röntgenbilder ermöglicht die Darstellung anteriorer Ossifikationen, welche trotz medikamentöser Ossifikationsprophylaxe relativ häufig auftreten. Diese Ossifikationen bleiben nach den ersten 12 Monaten radiologisch stationär und verursachen in der Regel keine klinisch relevanten Beschwerden.

Abstract

Aim: This retrospective study investigates the incidence of anterior intertrochanteric ossifications (AIO), especially in comparison with heterotopic ossifications classified according to Brooker. A classification system of AIO regarding short-term results (< 1 year after surgery) was introduced in 2003: AIO occurred solely in 13 % of all cases (ossifications according to Brooker grade 0) and would have been “overlooked” without a lateral X‐ray. The incidence of AIO combined with ossifications according to Brooker > 0 was 48.8 % of all cases. Our study reports long-term results, furthermore correlations between ossifications and clinical outcome, rated by the Harris hip score (HHS) and range of motion (ROM), are evaluated. Material and Methods: 149 cementless total hip arthroplasties (Hofer-Imhof threaded cup, straight stem), implanted into 140 patients from November 1991 to December 1994 underwent complete clinical and radiological follow-up from December 2005 to October 2006. The average age of the 81 female and 59 male patients at the time of implantation was 64 years. Without exception, a conventional, transgluteal approach (Bauer) was performed. All patients received indomethacin prophylaxis for 8 consecutive days after surgery. Current X-rays (a.–p. and lateral view) were evaluated in comparison with the former X-rays. Results: AIO were found in 77 cases (51.7 %), heterotopic ossifications corresponding to Brooker in 93 cases (62.4 %), a combination of AIO and Brooker in 58 cases (38.9 %) and solitary AIO in 19 cases (12.8 %). HHS and ROM were not significantly altered by ossifications. Conclusion: Our long-term findings compare with the short-term results (indicating lack of new bone formation [heterotopic ossification] after more than one year after surgery, as previously described in the literature concerning ossifications according to Brooker) and verify the incidence rate of solitary AIO. Despite a minor correlation with clinical outcome, AIO could be considered as a possible indicator for predilection of heterotopic bone formation, especially if revision arthroplasty or THA of the contralateral side is needed.

Schlüsselwörter

Hüfttotalendoprothese - Ossifikationen - anterior - Langzeitverlauf - ROM - heterotopisch

Key words

THA - ossifications - anterior - long‐term - ROM - heterotopic

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