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Allogene Knochentransplantation in der Hüftrevisionsendoprothetik

Indikationen und Rekonstruktionsmöglichkeiten

Allogeneic bone transplantation in hip revision surgery

Indications and potential for reconstruction

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Zusammenfassung

Mit der steigenden Anzahl von Endoprothesenträgern wird die Revision von Hüftendoprothesen weiter zunehmen. Die Rekonstruktion ossärer Defekte mit allogenen Knochen ermöglicht die Wiederherstellung eines knöchernen Lagers und verbessert die langfristige Verankerung und die Resultate. Eine ausreichende Primärstabilität des gewählten Konstrukts ist Voraussetzung für ein gutes klinisches Ergebnis und die langfristige ossäre Integration, ebenso wie ein guter Kontakt des implantierten Knochens zum Knochenlager. Die Knochentransplantation kann zu einem „Down-Grading“ eines knöchernen azetabulären Defekts beitragen und die Verwendung eines größeren Stützimplantats vermeiden. Auch bei der Rekonstruktion femoraler Defekte kann die Knochentransplantation das Knochenlager verbessern und die Implantation eines kleineren Schafts ermöglichen, allerdings sind der Indikationsstellung bei sehr ausgeprägten Defektzonen Grenzen gesetzt. Aufgrund der guten langfristigen Ergebnisse der modularen Revisionsschäfte hat sich das „Impaction-Bone-Grafting“ im Bereich des Schaftes nicht generell etabliert.

Abstract

The increasing number of people having joint replacements will lead to increasing numbers of revision operations. The transplantation of allogeneic bones might reconstruct bone defects and improve long-term anchorage of the implant. A sufficient primary stability of the implanted construct is necessary to achieve osseous incorporation as well as tight contact between the implanted allogeneic and host bones. Transplantation of bone can contribute to downgrading acetabular defects and so avoid bigger reinforcement implants. An improvement of bone stock due to reconstruction of femoral bony defects might also reduce the size of the stem necessary since the indication might be limited in case of extensive bone defects. According to good longterm results of modular revision stems the Impaction-Bone-Grafting has not yet generally been established.

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Abbreviations

AAOS:

American Academy of Orthopaedic Surgeons

DGOT:

Deutsche Gesellschaft für Orthopädie und Traumatologie

PE:

Polyethylen

TEP:

Totalendoprothese

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Danksagung

Für die Bereitstellung der Röntgenaufnahmen danken wir Frau Prof. Dr. G. Krombach.

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  1. Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie, Justus-Liebig-Universität Gießen, Klinikstraße 33, 35392, Gießen, Deutschland

    G. A. Ahmed, B. Ishaque, M. Rickert & C. Fölsch

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Ahmed, G.A., Ishaque, B., Rickert, M. et al. Allogene Knochentransplantation in der Hüftrevisionsendoprothetik. Orthopäde 47, 52–66 (2018). https://doi.org/10.1007/s00132-017-3506-3

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