Zusammenfassung
Die periprothetische Femurfraktur ist in der primären Hüftendoprothetik eine eher seltene Komplikation. Das intraoperative Frakturrisiko liegt bei weniger als 1 % für zementierte Implantate und bei 3–20 % für unzementierte Implantate (Fitzgerald et al. 1988; Schwartz et al. 1989; Stuchin 1990). Postoperative periprothetische Frakturen sind, mit insgesamt weniger als 1 % Häufigkeit gar noch seltener (Blatter et al. 1989; Moran et al. 1996; Zuber et al. 1990). Berry (1999) fasste die Epidemiologie der periprothetischen Frakturen wie folgt zusammen (s. auch Tab. 15.1): 0,3 % von insgesamt 20.859 zementierten und 5,4 % von insgesamt 3121 zementfreien Hüftprothesen wiesen eine intraoperative Femurfraktur auf. Dagegen muss bei 4 % aller Reoperationen mit einer periprothetischen Fraktur gerechnet werden (Berry 1999; Kavanagh 1992). Aufgrund der steigenden Inzidenz von Endoprothesen nimmt auch die Anzahl der Revisionsfälle zu, die oft komplexere operative Behandlungen erfordern. Es wird deshalb zunehmend wichtiger, die risikoreichen Patienten früh zu erkennen, um potentiell den Problemen vorbeugen zu können. Patienten mit osteoporotischem oder pathologischem Knochen, wie oft im Zusammenhang mit Morbus Paget beobachtet, rheumatischen Krankheiten oder als Nebenwirkung von Glukokortikoiden, sind besonders gefährdet (Duncan und Masri 1995; Scott et al. 1975). Zusätzlich ist bekannt, dass die Inzidenz periprothetischer Femurfrakturen in der Revisionschirurgie erhöht ist, wobei es durchschnittlich in 3,5–6,3 % der zementierten und 16,3–20,9 % der zementfreien Prothesenwechsel zu einer Fraktur kommen kann (Berry 1999; Christensen et al. 1989).
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Reindl, R., Schatzker, J. (2012). Hüftgelenk und Femur: Periprothetische Frakturen. In: Haas, N., Krettek, C. (eds) Tscherne Unfallchirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-68741-2_15
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