Kurzfristige Ergebnisse der Interpositionsarthroplastik mittels autologem Femurkopfresektat in Kombination mit zementfreien Schraubpfannen zur Behandlung der Dysplasiecoxarthrose

Zusammenfassung:

Fragestellung: In der vorliegenden prospektiven klinischen Studie werden kurzfristige Ergebnisse nach Interpositionsarthroplastik mittels autologem Femurkopfresektat in Kombination mit zementfreien Schraubpfannen zur Behandlung der Dysplasiecoxarthrose vorgestellt. Ferner wird dezidiert auf das operative Verfahren eingegangen. Methode: 34 Patienten mit Dysplasiekoxarthrose wurden zwischen 1995 und 1997 mit einer autologen Spanplastik bei zementfreier Totalendoprothese versorgt. Das Transplantat wird press-fit zwischen Knochen und lmplantat eingebracht. Durchschnittliches Alter 53,2 Jahre (24 - 74 Jahre). Durchschnittlicher Nachuntersuchungsraum: 2 Jahre (1 Jahr bis 2,5 Jahre). Ergebnisse: Der Harris-Hip-Score verbesserte sich von präoperativ 32 Punkte (min. 14 P, max. 61 P) auf 82 Punkte (min. 54 P, max. 91 P). 30 Hüften wurden mit sehr gut und gut bewertet, eine befriedigend und eine schlecht. Die radiologische Nachuntersuchung zeigte in einer Hüfte eine Aufhellung um die Pfanne (Lysesaumbildung nach DeLee und Charnley Typ II in Zone III). Heterotope Ossifikationen traten in 11 von 31 Hüften auf (7 × Typ 1, 3 × Typ II, und 1 × Typ III nach Brooker). Es wurde eine Pfannenlockerung beobachtet. Schlussfolgerung: Die gezeigte lnterpositionsarthroplastik mit autologem, quaderförmigen oder konischen press-fit verankertem Knochen in Kombination mit einer Schraubpfanne zeigt gute kurzfristige Resultate. Auf eine Fixation mit Schrauben kann in der Regel verzichtet werden.

Introduction: The operative treatment of arthritis in congenital dysplastic hips (CDH) with an autologous femoral head graft is a well established technique in total joint arthroplasty. This prospective study introduces a new operative technique in which the fixation of the autologous bone graft is achieved through the threaded Zweymueller cup solely. Early results are presented. Method: 34 patients, (average age of 53.2 years, 24 to 74 years) with CDH had a total joint arthroplasty in combination with a femoral head autograft between 1995 and 1997 (32 patients in study). The fixation of the bone graft was achieved with screws or with a press-fit technique through the threaded cup. The results are described with an average of 2 years. Results: The patients were followed prospectively for an average of 2 years. The Harris hip score increased from 32 preoperatively (range 14 - 61) to 82 (range 54 to 91) postoperatively. 30 hips had excellent and good results, one satisfactory and one had an unsatisfactory result. Radiographic evaluation demonstrated no osteolysis, one radiolucency was seen in Zone III of the acetabulum and heterotopic bone formation was observed in 11 of 31 radiographically evaluated hips (Brooker type I: 7, type II: 3 and type III: 1). All bone grafts achieved union, all grafts survived, and all acetabular components survived, but one. There were no complications such as dislocation, infection, nerve palsy, or a thrombo-embolic event observed. Conclusion: Fixation of the femoral head autograft in CDH with a threaded cup solely showed no disadvantages over the established fixation technique with screws over a short-term follow-up. A solid stable fixation of the graft with a threaded Zweymueller cup was achieved and resulted in full graft integration without the use of screws.

Schlüsselwörter:

Dysplasiekoxarthrose - autologes Knochenspantransplantat - lnterpositionsarthroplastik - zementfreie Pfannenimplantation

Key words:

uncemented hip prosthesis - arthritis and congenital dysplasia of the hip - bone grafting (autogenous femur head)

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