Keramik-Keramik-Gleitpaarungen in der primären Hüftendoprothetik

Zusammenfassung

Die Hauptursache für die Revision in der Hüftendoprothetik ist die abriebbedingte aseptische Lockerung. Jüngere und aktive Patienten nach endoprothetischem Gelenkersatz führen zu hohen Beanspruchungen insbesondere der Gleitpaarungen. Die Fortschritte, vor allem für Aluminiumoxid-Keramik-Keramik-Gleitpaarungen und bei Mischkeramiken, haben viele Probleme der Vergangenheit gelöst und führen zu guten In-vitro-Resultaten. Moderne Keramiken (Aluminiumoxid oder Mischkeramiken mit Aluminiumoxid) sind extrem hart, kratzfest, biokompatibel, haben einen niedrigen Reibungskoeffizienten, zeigen hervorragende Lubrikationseigenschaften und weisen die geringsten Abriebraten im Vergleich zu allen anderen in der Hüftendoprothetik eingesetzten Gleitpaarungen auf. Der Nachteil von Keramiken ist das Risiko des Materialversagens, d. h. des Keramikbruchs. Die neue Generation von Mischkeramiken (Delta-Keramik), hat das Risiko von Kopfbrüchen auf 0,03–0,05 % reduziert, das Risiko für Inlay-Brüche blieb mit etwa 0,02 % jedoch unverändert. Unter der Annahme einer impingementfreien Komponentenimplantation haben Keramik-Keramik-Gleitpaarungen wesentliche Vorteile gegenüber den anderen Gleitpaarungskombinationen. Aufgrund der Materialhärte, produzieren Keramik-Keramik-Gleitpaarungen weniger Drittkörperabrieb und sind praktisch unempfindlich gegen Beschädigungen durch Instrumente während der Operation. Eine spezifische Komplikation für Keramik-Keramik-Gleitpaarungen ist die Geräuschentstehung („squeeking“). Die hohe Rate an in der Literatur beschriebenen Quietschphänomenen (0,45–10,7 %) unterstreicht die Bedeutung der exakten Implantatpositionierung, der Prothesenschaftauswahl und der Patientenselektion. Bei genauer Implantatpositionierung ist dieses Problem mit vielen Implantatdesigns selten und ohne klinische Relevanz. Die verbesserte Tribologie und die dadurch vermutlich resultierende Langlebigkeit machen Keramik-Keramik-Gleitpaarungen zur Gleitpaarung der Wahl für junge und aktive Patienten.

Abstract

The main reason for total hip arthroplasty (THA) revision is the wear-related aseptic loosening. Younger and active patients after total joint replacement create high demands, in particular, on the bearings. The progress, especially for alumina ceramic-on-ceramic bearings and mixed ceramics have solved many problems of the past and lead to good in vitro results. Modern ceramics (alumina or mixed ceramics containing alumina) are extremely hard, scratch-resistant, biocompatible, offer a low coefficient of friction, superior lubrication and have the lowest wear rates in comparison to all other bearings in THA. The disadvantage of ceramic is the risk of material failure, i.e., of ceramic fracture. The new generation of mixed ceramics (delta ceramic), has reduced the risk of head fractures to 0.03–0.05 %, but the risk for liner fractures remains unchanged at about 0.02 %. Assuming a non-impinging component implantation, ceramic-on-ceramic bearings have substantial advantages over all other bearings in THA. Due to the superior hardness, ceramic bearings produce less third body wear and are virtually impervious to damage from instruments during the implantation process. A specific complication for ceramic-on-ceramic bearings is “squeaking”. The high rate of reported squeaking (0.45 to 10.7 %) highlights the importance of precise implant positioning and the stem and patient selection. With precise implant positioning this problem is rare with many implant designs and without clinical relevance. The improved tribology and the presumable resulting implant longevity make ceramic-on-ceramic the bearing of choice for young and active patients.

Schlüsselwörter

primäre Hüftendoprothetik - Keramikgleitpaarung - Abrieb

Key words

primary THA - ceramic-on-ceramic bearings - wear

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