Zusammenfassung
Die endoprothetische Versorgung der Hüfte kann primär bei Azetabulumfrakturen und sekundär nach konservativer oder vorausgegangener Osteosynthese erfolgen. Es bedarf einer individuellen Indikationsstellung. Patientenalter, Frakturmorphologie, Knochenqualität und eine vorbestehende Koxarthrose sind wesentliche Entscheidungskriterien. Neben ausreichend Erfahrung in der Revisionsendoprothetik, sind insbesondere bei der Versorgung von frischen Frakturen Kenntnisse der Azetabulumchirurgie notwendig. Es gilt die Frakturmorphologie sowie die azetabuläre Defektsituation und die Position des einliegenden Osteosynthesematerials exakt zu analysieren. Die meisten posttraumatischen Gelenke sind mit zementfreien Pfannen, meist mit zusätzlichen in die unterschiedlichen Pfannenregionen eingebrachten Schrauben zu versorgen. Nach sicherem Infektausschluss sind ein Belassen oder eine partielle Entfernung des Osteosynthesematerials ausreichend. Bei frischen Azetabulumfrakturen kommt je nach Frakturmorphologie eine Revisionspfanne und/oder ein Abstützring gegebenenfalls mit additiver Osteosynthese zum Einsatz. Beim älteren Patienten muss das Therapieziel in erster Linie die schnelle Mobilisierung durch eine stabile einzeitige operative Versorgung sein, um das Komplikations-, Revisions- und Mortalitätsrisiko auf ein Minimum zu reduzieren. Die Ergebnisse sind mit denen der Hüftrevisionsendoprothetik vergleichbar.
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Hipfl, C. (2023). Hüftendoprothethik bei speziellen Bedingungen: Endoprothetik nach Azetabulumfrakturen. In: Perka, C., Heller, KD. (eds) AE-Manual der Endoprothetik. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-55485-2_90-1
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