Postoperative radiologische Beurteilung von Gelenkendoprothesen

Zusammenfassung

Mit der Zunahme der Lebenserwartung in den Industrieländern, den Fortschritten in der Entwicklung des Implantatdesigns wie auch der Implantationstechnik werden Gelenkprothesen zunehmend häufiger eingebracht.

Neben dem häufig vorgenommenen Hüft- und Kniegelenkersatz sind endoprothetische Eingriffe auch an einer Vielzahl anderer Gelenke möglich. Die radiologische Bildgebung ist postoperativ ein entscheidendes Werkzeug für die Beurteilung des Operationsergebnisses und die Erkennung von Früh- und Spätkomplikationen.

Im folgenden Beitrag wird auf die Bedeutung unterschiedlicher bildgebender Verfahren und auf ihren systematischen Einsatz in der postoperativen Betreuung von Patienten mit einem Gelenkersatz eingegangen.

Abstract

With increased life expectancy in industrialised countries, improvement of implant design and operative technique, arthroplasty has become a routine procedure.

The hip and knee joints are treated by arthroplasty most frequently. Nowadays joint replacement can be performed in many other joints. Radiologic imaging is an important tool for evaluation of the operative results and for detection of early and late complications.

In the following article we describe the relevance of different imaging modalities as well as their systematic application in patients with joint arthroplasty.

Arthroplasty; Arthrosis; Postoperative imaging; Complication; Prosthesis position; Signs of loosening

Literatur

• 1 Bernau A. Orthopädisch-Traumatologische Röntgendiagnostik. München; Elsevier 2004: 179-222
• 2 Devane P A, Bourne R B, Rorabeck C H, MacDonald S, Robinson E J. Measurement of polyethylene wear in metal-backed acetabular cups. II. Clinical application.  Clin Orthop. 1995;  319 317-326
• 3 Aldinger P R, Breusch S J, Lukoschek M, Mau H, Ewerbeck V, Thomsen M. A ten- to 15-year follow-up of the cementless spotorno stem.  J Bone Joint Surg Br. 2003;  85 209-214
• 4 Krismer M, Biedermann R, Stockl B, Fischer M, Bauer R, Haid C. The prediction of failure of the stem in THR by measurement of early migration using EBRA-FCA. Einzel-Bild-Roentgen-Analyse-femoral component analysis.  J Bone Joint Surg Br. 1999;  81 273-280
• 5 Kummer F J, Shah S, Iyer S, Di Cesare P E. The effect of acetabular cup orientations on limiting hip rotation.  J Arthroplasty. 1999;  14 509-513
• 6 Devane P A, Bourne R B, Rorabeck C H, Hardie R M, Horne J G. Measurement of polyethylene wear in metal-backed acetabular cups. I. Three-dimensional technique.  Clin Orthop. 1995;  319 303-316
• 7 Harris W H. The problem is osteolysis.  Clin Orthop. 1995;  311 46-53
• 8 Ritter M A, Faris P M, Keating E M, Brugo G. Influential factors in cemented acetabular cup loosening.  J Arthroplasty. 1992;  7 (Suppl) 365-367
• 9 Gruen T A, McNeice G M, Amstutz H C. „Modes of failure” of cemented stem-type femoral components:a radiographic analysis of loosening.  Clin Orthop. 1979;  141 17-27
• 10 Breusch S J, Aldinger P R, Thomsen M, Ewerbeck V, Lukoschek M. Anchoring principles in hip endoprostheses. I: Prosthesis stem.  Unfallchirurg. 2000;  103 918-931
• 11 Breusch S J, Lukoschek M, Kreutzer J, Brocai D, Gruen T A. Dependency of cement mantle thickness on femoral stem design and centralizer.  J Arthroplasty. 2001;  16 648-657
• 12 Breusch S J, Schneider U, Kreutzer J, Ewerbeck V, Lukoschek M. Effects of the cementing technique on cementing results concerning the coxal end of the femur.  Orthopade. 2000;  29 260-270
• 13 Breusch S J, Schneider U, Reitzel T, Kreutzer J, Ewerbeck V, Lukoschek M. Significance of jet lavage for in vitro and in vivo cement penetration.  Z Orthop Ihre Grenzgeb. 2001;  139 52-63
• 14 Barrack R L, Mulroy Jr R D , Harris W H. Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty. A 12-year radiographic review.  J Bone Joint Surg Br. 1992;  74 385-389
• 15 Neumann L, Freund K G, Sorenson K H. Long-term results of Charnley total hip replacement. Review of 92 patients at 15 to 20 years.  J Bone Joint Surg Br. 1994;  76 245-251
• 16 Emery D F, Clarke H J, Grover M L. Stanmore total hip replacement in younger patients: review of a group of patients under 50 years of age at operation.  J Bone Joint Surg Br. 1997;  79 240-246
• 17 Verdonschot N, Tanck E, Huiskes R. Effects of prosthesis surface roughness on the failure process of cemented hip implants after stem-cement debonding.  J Biomed Mater Res. 1998;  42 554-559
• 18 Barker D S, Wang A W, Yeo M F, Nawana N S, Brumby S A, Pearcy M J, Howie D W. The skeletal response to matt and polished cemented femoral stems.  J Bone Joint Surg Br. 2000;  82 1182-1188
• 19 Neumann L, Freund K G, Sorensen K H. Total hip arthroplasty with the Charnley prosthesis in patients fifty-five years old and less. Fifteen to twenty-one-year results.  J Bone Joint Surg Am. 1996;  78 73-79
• 20 Ritter M A. The all-polyethylene cemented socket may still be the best choice.  Orthopedics. 1999;  22 827-828
• 21 Karrholm J, Borssen B, Lowenhielm G, Snorrason F. Does early micromotion of femoral stem prostheses matter? 4-7-year stereoradiographic follow-up of 84 cemented prostheses.  J Bone Joint Surg Br. 1994;  76 912-917
• 22 Aldinger P R, Sabo D, Pritsch M, Thomsen M, Mau H, Ewerbeck V, Breusch S J. Pattern of periprosthetic bone remodeling around stable uncemented tapered hip stems: a prospective 84-month follow-up study and a median 156-month cross-sectional study with DXA.  Calcif Tissue Int. 2003;  73 115-121
• 23 Aldinger P R, Thomsen M, Mau H, Ewerbeck V, Breusch S J. Cementless Spotorno tapered titanium stems:excellent 10 - 15-year survival in 141 young patients.  Acta Orthop Scand. 2003;  74 253-258
• 24 Bauer T W, Schils J. The pathology of total joint arthroplasty II. Mechanisms of implant failure.  Skeletal Radiol. 1999;  28 483-497
• 25 Devane P A, Horne J G. Assessment of polyethylene wear in total hip replacement.  Clin Orthop. 1999;  369 59-72
• 26 Goodfellow J, O'Connor J, Murray D W. The Oxford meniscal unicompartmental knee.  J Knee Surg. 2002;  15 240-246
• 27 Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifka J. Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique.  J Bone Joint Surg Br. 2004;  86 682-687
• 28 Taljanovic M SJM, Hunter T B, Benjamin J B, Ruth J T, Brown A W, Sheppard J E. Joint arthroplasties and prostheses.  Radiographics. 2003;  23 1295-1314
• 29 Hintermann B, Valderrabano V, Dereymaeker G, Dick W. The HINTEGRA ankle: rationale and short-term results of 122 consecutive ankles.  Clin Orthop. 2004;  424 57-68
• 30 White L M, Mehta M, Merchant N, Schweitzer M E, Morrison W B, Hutchison C R, Gross A E. Complications of total hip arthroplasty: MR imaging-initial experience.  Radiology. 2000;  215 254-262