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DOI: 10.1055/s-0035-1545872
Proximale Femurfrakturen bei liegender Hüftgelenkstotalendoprothese
Proximal Femoral Fractures around a Total Hip ArthroplastyPublication History
Publication Date:
05 August 2015 (online)
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Zusammenfassung
Die Inzidenz periprothetischer Frakturen am proximalen Femur bei liegender Hüftgelenksprothese nimmt aufgrund der demografischen Entwicklung und der damit verbundenen höheren Lebenserwartung, der steigenden Zahl der implantierten Prothesen sowie des vermehrten Auftretens von Osteoporose und des höheren Aktivitätsniveaus der älteren Bevölkerung zu. Neben der Lokalisation der Fraktur und der Stabilität der Prothese sind insbesondere auch patientenspezifische individuelle Faktoren für die Planung des therapeutischen Vorgehens zu berücksichtigen. Für diese Frakturform hat sich in den letzten Jahren die Vancouver-Klassifikation nach Duncan und Masri im klinischen Alltag durchgesetzt. Sie berücksichtigt neben der Lokalisation der Fraktur und der Stabilität der Prothese auch die Knochenqualität und liefert so Hinweise für die Auswahl des richtigen Behandlungsverfahrens. Die Therapie der proximalen periprothetischen Femurfraktur ist sehr differenziert und reicht von der konservativen Therapie über die operative Stabilisierung bis hin zum totalen endoprothetischen Femurersatz, und sollte unter optimaler Vorbereitung und besten Operationsbedingungen an spezialisierten Zentren erfolgen. Neue interdisziplinäre multimodale Therapieansätze können helfen, der zu erwartenden weltweiten Zunahme der periprothetischen Frakturen zu begegnen.
Abstract
The incidence of periprosthetic fractures around a total hip arthroplasty is increasing with the demographic development involving the increased expectation of life, the increased number of endoprostheses and the increased incidence of osteoporosis in combination with higher levels of activity in the elderly population. In addition to the localisation of the fracture and the stability of the prosthesis, especially patient-specific aspects must be taken into account when planning the therapeutic procedure. The Vancouver classification developed by Duncan and Masri has prevailed for this type of fracture in the past years in clinical practice. It considers not only the location of the fracture and the stability of the prosthesis but also the bone quality and thus provides hints for the selection of the right therapeutic procedure. The therapy for the periprosthetic proximal femoral fracture is very differentiated ranging from conservative treatment over surgical stabilisation to total femoral replacement and should therefore be carried out under optimum preparation and operation conditions at specialised centres. New interdisciplinary multimodal treatment approaches will help us to manage the expected global increase of periprosthetic fractures.
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