Der Einfluss von biomechanischen Prinzipien und Material auf das Design von Hüftendoprothesen

Zusammenfassung

Die Hüftendoprothetik entwickelte sich aus der Hüftgelenkresektion über die Interpositionsarthroplastik bis zur modernen Alloarthroplastik (Hüft-Total-Endoprothese). Design, biomechanische Konzepte und Werkstoffeigenschaften waren die limitierenden Faktoren der letzten 50 Jahre. Unterschiedliche Gleitpaarungen und Verankerungskonzepte schufen eine Vielzahl von Formen von Endoprothesen. Verlässlichkeit und Standzeit der Hüftendoprothesen ist bei allen Prinzipien als sehr gut zu bewerten. Quervernetzte Polyethylene in Kombination mit Aluminiumoxidkeramiken stellen heute den Standard der Gleitpaarungen dar. Verbesserte Abriebeigenschaften der quervernetzten Polyethylene ermöglichen dünnere Pe-Liner (Einsätze) im Pfannenersatz. Hart-Hart-Metall-Paarungen konnten die in sie gestellten Erwartungen bislang nicht erfüllen. Vielversprechenden Resultate werden mit Keramik-Keramik-Gleitpaarungen erreicht, die jedoch weniger fehlerverzeihend sind. Zementierte und nicht zementierte Verankerungstechniken sind als gleichwertig anzusehen. Der Trend der letzten Jahre zu gröβeren Köpfen in der Gleitpaaarung konnte seine theoretischen Vorteile klinisch nicht unter Beweis stellen.

Abstract

The treatment of the hip joint has evolved from resection arthroplasty to total hip arthroplasty. Design, biomechanical concepts, and material properties were limiting factors over the past 50 years. Tribology and fixation generated different shapes, with excellent reliability and life of duration after implantation. Cross-linked polyethylenes combined with alumina oxide ceramics are the excellent standard in tribology. Hard-on-hard bearings (metal-metal) did not meet the expectations, however, promising results are obtained with ceramic-on-ceramic articulations. Cemented and uncemented fixation are both well evaluated in THA.

Schlüsselwörter

Design - Total Endoprothese Hüfte HTEP - Biomechanik - Werkstoff - Gleitpaarung

Key words

design - THA total hip arthroplasty - biomechanics - material characteristics - tribology

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