Hüftendoprothetik – Verankerungstechnik, Prothesengröße und Material der artikulierenden Komponenten

Die Hüftendoprothetik hat in den letzten 6 Jahrzehnten eine rasante Entwicklung durchgemacht und sich als eine der sichersten und erfolgreichsten Operationsmethoden in der Orthopädie etabliert. Mit der hohen Anzahl an Eingriffen in Deutschland stellt diese Operation auch einen ökonomisch bedeutsamen Faktor für viele Krankenhäuser dar. Parallel zu den Operationszahlen ist auch die Anspruchshaltung der Patienten gestiegen.

Nach wie vor weisen die zementierten Prothesen eine lange Standzeit auf, an der sich die verschiedenen zementfreien Systeme messen lassen müssen. Die Vorteile der zementfreien Prothesensysteme liegen vor allem in der besseren Biologie, jüngste Entwicklungen gehen hier zu den kurzen Schäften. Fortschritte wurden auch in der Tribologie gemacht. Die neuen Keramiken sind deutlich stabiler und haben gegenüber den Metall-Metall-Laufwerken den Vorteil des geringeren und vor allem inerten Abriebs. Gleichzeitig hat der Oberflächenersatz an Bedeutung verloren.

Weniger invasive Operationstechniken ermöglichen eine schnellere Rehabilitation, ein langfristig anhaltender Vorteil ist bis jetzt aber nicht bewiesen. Parallel zu der steigenden Zahl an Implantationen eines künstlichen Hüftgelenks nimmt auch die Inzidenz der Revisionen und der periprothetischen Frakturen zu. Diese Entwicklung stellt die Herausforderung der Zukunft dar.

Total hip arthroplasty has undergone dramatic developments in the past six decades and has become established as one of the safest and most successful surgical methods in orthopedics. With the large number of interventions in Germany this operation also represents a significant economic factor for many hospitals. The expectations of the patients have also increased in parallel with the increased number of procedures.

Cemented prostheses continue to exhibit a long servicable life-time with which the various non-cemented systems have to stand in comparison. The advantages of the cement-free prosthetic systems lie above all in their better biology, and recent developments in this respect favor short shafts. Progress has also been made in tribology. The new ceramics are markedly more stable and have the advantage of lower and above all inert wear particles in comparison to the metal-on-metal systems. At the same time the surface-replacement prosthesis has become less important.

Less invasive surgical techniques enable a more rapid rehabilitation, but as yet a long-lasting advantage has not been demonstrated. In parallel to the increasing number of implantations of artificial hip joints, the incidences of revision operations and periprosthetic fractures are also increasing. Just these developments constitute a challenge for the future.

Key words

Total hip arthroplasty - cemented and cementless technique - short stem - wear - loosening - periprosthetic fracture - revision surgery

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