Anatomische Rekonstruktion des Hüftgelenks mit der schenkelhalserhaltenden Silent Micro Hip™

 

 Buy Article Permissions and Reprints

Zusammenfassung

Hintergrund: Das Design und die Implantationstechnik der Silent Micro Hip™ unterscheiden sich von herkömmlichen Prothesentypen durch die konische Verankerung im Schenkelhals. Ziel der vorliegenden Studie war es, die biomechanische Rekonstruktion des Hüftgelenks mit der Silent Micro Hip™ zu analysieren und mit anderen Kurz- und Standardschäften zu vergleichen. Zudem wurden implantatspezifische Besonderheiten herausgearbeitet. Methoden: Zur Evaluation der biomechanischen Parameter wurden die prä- und postoperativen Beckenübersichtsaufnahmen von 150 konsekutiven Patienten (je 50 Silent Micro Hip™, Nanos™ und SL-Plus™ MIA) retrospektiv verglichen. Ergebnisse: Die Veränderung des horizontalen femoralen Offsets und die Veränderung der Beinlänge zeigten keinen signifikanten Unterschied zwischen der Silent Micro Hip™ und den anderen beiden Prothesentypen. Mit allen Prothesentypen konnte eine nahezu anatomische Rekonstruktion des Drehzentrums erreicht werden. Schlussfolgerungen: Durch die Silent Micro Hip™ lässt sich das Hüftgelenk annähernd anatomisch rekonstruieren. Diese kurzfristigen Ergebnisse der biomechanischen Parameter unterstützen die knochensparende Hüftgelenksrekonstruktion mit proximaler femoraler Krafteinleitung. Weitere Studien über die Mittel- und Langzeitergebnisse müssen folgen.

Abstract

Background: The design and the surgical technique of the Silent Micro Hip™ are different compared to other hip stems due to a conical shape for fixation within the metaphyseal femur. The purpose of the present study was to evaluate hip joint biomechanics of the Silent Micro Hip™ in comparison to other implants. Implant-specific differences are highlighted. Material and Method: 150 consecutive patients (each group 50 Silent Micro Hip™, Nanos™ and SL-Plus™ MIA) were analysed retrospectively. For evaluation of biomechanical parameters pre- and postoperative X-rays (pelvic AP views) were used. Results: The horizontal femoral offset and the limb length showed no significant difference between the Silent Micro Hip™ and the Nanos™ or SL-Plus™ MIA stem at the reconstructed hip. An almost anatomic reconstruction of hip joint biomechanics was reached with all three types of implants.

Conclusions: The Silent Micro Hip™ allows for almost anatomic reconstruction of hip joint biomechanics. Short-term results support the bone-preserving reconstruction with a proximal femoral load transfer. Further studies on the mid- and long-term outcomes are ongoing.

• Literatur

• 1 Effenberger H, Imhof M, Witzel U et al. Zementfreie Hüftschäfte. Aktueller Stand. Orthopäde 2005; 34: 477-500
  PubMedGoogle Scholar
• 2 Eingartner C, Heigele T, Dieter J et al. Long-term results with the BiCONTACT system – aspects to investigate and to learn from. Int Orthop 2003; 27: 11-15
  Google Scholar
• 3 Reigstad O, Siewers P, Røkkum M et al. Excellent long-term survival of an uncemented press-fit stem and screw cup in young patients: follow-up of 75 hips for 15–18 years. Acta Orthop 2008; 79: 194-202
  CrossrefPubMedGoogle Scholar
• 4 Kinkel S, Wollmerstedt N, Kleinhans JA et al. Patient activity after total hip arthroplasty declines with advancing age. Clin Orthop Relat Res 2009; 467: 2053-2058
  CrossrefPubMedGoogle Scholar
• 5 Glyn-Jones S, Pandit H, Kwon YM et al. Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg [Br] 2009; 91: 1566-1574
  PubMedGoogle Scholar
• 6 Heisel C, Thomsen M, Jakubowitz E et al. Particle release in metal-on-metal bearings. A risk analysis. Orthopäde 2008; 37: 644-649
  CrossrefPubMedGoogle Scholar
• 7 Boardman DR, Middleton FR, Kavanagh TG. A benign psoas mass following metal-on-metal resurfacing of the hip. J Bone Joint Surg [Br] 2006; 88: 402-404
  PubMedGoogle Scholar
• 8 Campbell P, Shimmin A, Walter L et al. Metal sensitivity as a cause of groin pain in metal-on-metal hip resurfacing. J Arthroplasty 2008; 23: 1080-1085
  CrossrefPubMedGoogle Scholar
• 9 Gruber FW, Bock A, Trattnig S et al. Cystic lesion of the groin due to metallosis: a rare long-term complication of metal-on-metal total hip arthroplasty. J Arthroplasty 2007; 22: 923-927
  CrossrefPubMedGoogle Scholar
• 10 Pandit H, Glyn-Jones S, McLardy-Smith P et al. Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg [Br] 2008; 90: 847-851
  PubMedGoogle Scholar
• 11 Gulow J, Scholz R, Freiherr von Salis-Soglio G. Kurzschäfte in der Hüftendoprothetik. Orthopäde 2007; 36: 353-359
  PubMedGoogle Scholar
• 12 Morrey BF. Short-stemmed uncemented femoral replacement component. Clin Orthop Relat Res 1989; 249: 169-175
  PubMedGoogle Scholar
• 13 Kiyama T, Naito M, Shinoda T et al. Hip abductor strengths after total hip arthroplasty via the lateral and posterolateral approaches. J Arthroplasty 2010; 25: 76-80
  CrossrefPubMedGoogle Scholar
• 14 Lecerf G, Fessy MH, Philippot R et al. Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty. Orthop Traumatol Surg Res 2009; 95: 210-219
  CrossrefPubMedGoogle Scholar
• 15 McGrory BJ, Morrey BF, Cahalan TD et al. Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty. J Bone Joint Surg Br 1995; 77: 865-869
  PubMedGoogle Scholar
• 16 Hube R, Zaage M, Hein W et al. Early functional results with the Mayo-hip, a short stem system with metaphyseal-intertrochanteric fixation. Orthopäde 2004; 33: 1249-1258
  PubMedGoogle Scholar
• 17 Tóth K, Mécs L, Kellermann P. Early experience with the DePuy Proxima™ short stem in total hip arthroplasty. Acta Orthop Belg 2010; 76: 613-618
  PubMedGoogle Scholar
• 18 Lerch M, von der Haar-Tran A, Windhagen H et al. Bone remodelling around the Metha short stem in total hip arthroplasty: a prospective dual-energy X-ray absorptiometry study. Int Orthop 2012; 36: 533-538
  CrossrefPubMedGoogle Scholar
• 19 Logroscino G, Ciriello V, DʼAntonio E et al. Bone integration of new stemless hip implants (proxima vs. nanos). A DXA study: preliminary results. Int J Immunopathol Pharmacol 2011; 24: 113-116
  PubMedGoogle Scholar
• 20 Morrey BF, Adams RA, Kessler M. A conservative femoral replacement for total hip arthroplasty. J Bone Joint Surg [Br] 2000; 82: 952-958
  CrossrefPubMedGoogle Scholar
• 21 Massin P, Geais L, Astoin E et al. The anatomic basis for the concept of lateralized femoral stems: a frontal plane radiographic study of the proximal femur. J Arthroplasty 2000; 15: 93-101
  CrossrefPubMedGoogle Scholar
• 22 Bicanic G, Delimar D, Delimar M et al. Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop 2009; 33: 397-402
  CrossrefPubMedGoogle Scholar
• 23 Little NJ, Busch CA, Gallagher JA et al. Acetabular polyethylene wear and acetabular inclination and femoral offset. Clin Orthop Relat Res 2009; 467: 2895-2900
  CrossrefPubMedGoogle Scholar
• 24 Schmidutz F, Beirer M, Weber P et al. Biomechanical reconstruction of the hip: comparison between modular short-stem hip arthroplasty and conventional total hip arthroplasty. Int Orthop 2012; 36: 1341-1347
  CrossrefPubMedGoogle Scholar
• 25 Kim YH, Kim JS, Park JW et al. Total hip replacement with a short metaphyseal-fitting anatomical cementless femoral component in patients aged 70 years or older. J Bone Joint Surg [Br] 2011; 93: 587-592
  PubMedGoogle Scholar