Intraoperative Femurfrakturen bei der Implantation des zementfreien BiCONTACT-Schaftes: eine Matched-Pair-Analyse von 84 Patienten

Zusammenfassung

Studienziel: Da das Problem intraoperativer periprothetischer Femurfrakturen (PFF) an Bedeutung gewinnt, war die Fragestellung dieser Studie, inwieweit das postoperative Ergebnis zementfreier Hüfttotalendoprothesen (Hüft-TEP) durch intraoperative PFFs mit Berücksichtigung der subjektiven körperbezogenen Patientenzufriedenheit beeinflusst wird. Methode: Von insgesamt 1216 primären Hüft-TEP-Implantationen mit dem zementfreien BiCONTACT-Primärschaft wurden 42 intraoperative PFFs (Typ Vancouver A und B1) anhand einer Matched-Pair-Analyse mit 42 Patienten ohne Frakturkomplikationen verglichen. Präoperativ und nach 2,2 Jahren (0,8 - 3,2 Jahre) wurden die Patienten klinisch und radiologisch untersucht. Klinische Parameter waren: Harris-Hip-Score, SF-36 Health Score, Bewegungs- und Schmerzscore, Hinken sowie postoperative Komplikationen. Radiologische Parameter waren: Knochenheilung sowie Trochanter- und Schaftmigration. Die Frakturen wurden nach der Vancouver-Klassifikation eingeteilt. Ergebnisse: Der Harris-Hip-Score und Bewegungsscore stiegen in beiden Gruppen signifikant an (p < 0,001), während der Schmerzscore in beiden Gruppen signifikant abfiel (p < 0,001). Der SF-36 Health Score stieg bei beiden Gruppen in fast allen Dimensionen signifikant an. Bis auf 2 Patienten mit Trochantermigration von 25 bzw. 20 mm heilten alle Frakturen knöchern aus. Bei 3 Patienten sinterten die Prothesen um 4,7 ± 2,9 mm ein, jedoch waren die Schäfte stabil und zeigten keine weitere Migration. 2 Schäfte in der Kontrollgruppe wurden gewechselt. Alle Unterschiede in den Häufigkeiten der postoperativen Komplikationen sowie der Scores waren zwischen den Gruppen nicht signifikant. Schlussfolgerung: Der zementfreie BiCONTACT-Primärschaft scheint trotz intraoperativer Vancouver-A- oder -B1-Fraktur mittelfristig zu vergleichbaren postoperativen Ergebnissen zu führen wie bei Implantationen ohne Frakturkomplikationen.

Abstract

Aim: Intraoperative periprosthetic femoral fractures (PFF) during the implantation of primary non-cemented total hip arthroplasties (THA) are an increasing problem. Thus, the goal of this study was to analyse the postoperative performance of primary non-cemented THA in patients with intraoperative PFFs, with respect to the patient's subjective health-related satisfaction. Method: 42 PFFs in 1216 primary THAs using the non-cemented BiCONTACT stem were monitored. Patients were compared to a control group of 42 non-cemented THA patients without intraoperative fracture complications, using the matched-pair analysis. Preoperative and after 2.2 years (0.8 - 3.2 years), patients were followed-up clinically and radiographically. Clinical parameters were Harris hip score, SF-36 health score, function and pain score and postoperative complications. Radiographic parameters were bone union, stem and trochanter migration. Fractures were graded using the Vancouver classification. Results: Results showed a significant increase in both Harris hip score and motion score and a significant decrease in pain score in both groups (p < 0.001). The SF-36 health score increased significantly in nearly every dimension in both groups. Except for 2 patients with trochanter migrations of 25 and 20 mm, all fractures showed bony union. In 3 patients the stems subsided by 4.7 ± 2.9 mm. The stems showed no further migration at final follow-up. 2 patients without intraoperative fractures underwent stem revision. Overall increases and postoperative complication rates were not significantly different between the groups. Conclusion: Mid-term THA performance and patient satisfaction are not influenced by intraoperative Vancouver A and B1 fractures during implantation of the non-cemented BiCONTACT stem compared to a collective without intraoperative fractures during implantation.

Schlüsselwörter

zementfreie Hüft‐TEP - BiCONTACT - intraoperative periprothetische Femurfraktur - Patientenzufriedenheit

Key words

cementless total hip arthroplasty - BiCONTACT - intraoperative periprosthetic femoral fracture - patient satisfaction

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