Skip to main content

Advertisement

SpringerLink
Log in

Modulare Femurendoprothese, bestehend aus einer Kombination von Kopfteil und Marknagel, bei Knochendefektsituationen des Femurs

Experience with a modular hip prosthesis consisting of a separate head and shaft component in patients with femoral bone defects

Klinische und radiologische ergebnisse

  • Originalarbeit
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Zusammenfassung

Die Anzahl an Patienten mit pertrochantären und periprothetischen Frakturen sowie mit aseptischer Prothesenlockerung nimmit kontinuierlich zu. Diese Patienten haben häufig eine Knochendefektsituation des proximalen Femurs. Wir berichten über die operativen, klinischen und radiologischen Ergebnisse bei diesen Indikationen nach Implantation einer modularen Huftprothese, die sich aus einem Prothesenteil und einem Schaft ähnlich eines Marknagels zusammensetzt.

109 Patienten werden prospektiv erfaßt. Die Klinikletalität lag bei 4,2%. Als häufigste intr-aoperative Komplikation traten sechs Femurfrakturen auf. 48 Patienten konnten in einem mittleren Zeitraum von 13,2 Monaten nachuntersucht werden, 25 Patienten waren bereits verstorben. Bei zwei Patienten mußte die modulare Hüftprothese wegen Lockerung gewechselt werden, zwei weitere zeigten radiologische Lockerungszeichen nach Versorgung einer periprothetischen Fraktur. Die Lebensqualität der Patienten, gemessen an einem modifizierten Harris-Score, war vergleichbar zum Zeitpunkt vor der Fraktur oder hat sich bei Wechseloperationen deutlich gebessert. Lockerungen der Prothesenverbindung traten nicht auf.

Die modulare Hüftprothese bietet eine hohe Variationsmöglichkeit in der Zusammensetzung and ist deshalb bei vielen Indikationen anwendbar. Unter Einschränkung der kurzen Nachbeobachtungszeit sind die radiologischen und klinischen Ergebnisse gut, wobei in Zukunft bei periprothetischen Frakturen die Primärstabilität der modularen Hüftprothese durch Knochentransplantate ergänzt werden sollte.

Abstract

There is an increasing number of patients with bone defects of the femur requiring primary or revision arthroplasty of the hip. Especially problematic in this respect are trochanteric fractures, periprosthetic fractures and aseptic loosening. We report about certain technical aspects, the postoperative course as well as clinical and radiological results after implantation of a modular hip prosthesis for these indications. The modular hip prosthesis consists of a separate head and shaft component with a stem similar to a femoral nail.

One hundred and nine patients were prospectively recorded. Hospital mortality was 4.2% and as major surgical complications there were 6 femoral fractures which occurred intraoperatively. Follow-up (mean 13,2 months) could be completed for 48 patients (25 patients had already died). Two patients showed aseptic loosening of modular hip prosthesis and revision with a cemented prosthesis was necessary. In 2 patients with a condition following a periprosthetic fracture radiological signs of loosening could be detected. Quality of life assessed by a modified Harris Hip Score was comparable to the situation prior the fracture or even better in the group following the implantation of modular hip prosthesis because of aseptic loosening.

Depending on the fact that 2 individual components, each of which coming in different sizes, can be assembled, the device shows a high degree of variability for different indications. Radiological and clinical results are good, however, follow-up time is too short for final evaluation. Periprosthetic fractures have to be treated more frequently by additional bone grafting in order to improve osseointegration of modular hip prosthesis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Andress HJ, Lob G, Kahl S, et al. Development of a new modular titanium femoral prosthesis consisting of a head and shaft component. Eur J Orthop Surg Traumatol 1999;9:13–8.

    Article  Google Scholar 

  2. Bouchard JA, Barei D, Cayer D, et al. Outcome of femoral shaft fractures in the elderly. Clin Orthop 1996;332:105–9.

    Article  PubMed  Google Scholar 

  3. Brown SA, Flemming JS, Kawalec JS, et al. Fretting corrosion accelerates crevice corrosion of modular hip tapers. J Appl Biomat 1995;6:19–26.

    Article  CAS  Google Scholar 

  4. Burt CF, Garvin KL, Otterberg ET, et al. A femoral component inserted without cement in total hip arthroplasty. A study of the Tri-Lock component with an average ten-year duration of follow-up. J Bone Joint Surg [Am] 1998;80:952–60.

    CAS  Google Scholar 

  5. Cameron HU. The two to six year results with a proximally modular noncemented total hip replacement used in hip revisions. Clin Orthop 1994;298:47–53.

    PubMed  Google Scholar 

  6. Chandler HP, Ayres DK, Tan RC, et al. Revision total hip replacement using the S-ROM femoral component. Clin Orthop 1995;319:130–40.

    PubMed  Google Scholar 

  7. Cooper C. The crippling consequences of fractures and their impact on quality of life. Am J Med 1997;3:12S-19S.

    Article  Google Scholar 

  8. Cossetto DJ, McCarthy JC, Bono JV, et al. Minimum four-year radiographic and clinical evaluation of resuls following femoral revision surgery with the S-ROM modular hip system. Acta Orthop Belg 1996;62:Suppl 1:135–47.

    PubMed  Google Scholar 

  9. D'Amonio JA, Capello WN, Manley MT. Remodelling of bone around hydroxyapatite coated femoral stems. J Bone Joint Surg [Am] 1996;78:1226–34.

    Google Scholar 

  10. Delaunay C, Cazeau C, Kapandji I. Cementless primary total hip replacement. 4–8 years result with the Zweymüller Alloclassic prosthesis. Int Orthop 1998;22:1–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Eingartner C, Volkmann R, Pütz M, et al. Uncemented revision stem for biological osteosynthesis in periprosthetic femoral fractures. Int Orthop 1997;21:25–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding and clinical results. J Bone Joint Surg [Br] 1987;69:45–55.

    CAS  Google Scholar 

  13. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop 1990;257:107–28.

    PubMed  Google Scholar 

  14. Gebauer D, Refior HJ, Haake M. Experimentelle Untersuchungen zum Einfluß operationstechnischer Fehler anf die Primärstabilität zementloser Hüftendoprothesen. Z Orthop 1990;128:100–7.

    Article  CAS  PubMed  Google Scholar 

  15. Grünig R, Morscher E, Ochsner PE. Three to seven year results with the uncemented SL femoral revision prosthesis. Arch Orthop Trauma Surg 1997;116:187–97.

    Article  PubMed  Google Scholar 

  16. Hartwig CH, Böhm P, Czech U, et al. The Wagner revision stem in alloarthroplasty of the hip. Arch Orthop Trauma Surg 1996;15:5–9.

    Article  Google Scholar 

  17. Hussamy O, Lachiewicz PF, Hill C. Revision total hip arthroplasty with BIAS femoral component. J Bone Joint Surg [Am] 1994;76:1137–48.

    CAS  Google Scholar 

  18. Huo ME, Fye MA, Martin RP, et al. Unsatisfactory results of a first-generation modular femoral stem implanted without cement. A 4 to 9 year follow up study. J Arthroplasty 1997;12:490–6.

    Article  CAS  PubMed  Google Scholar 

  19. Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. Br Med J 1993;307:1248–50.

    Article  CAS  Google Scholar 

  20. Kolstad K. Revision THR after periprosthetic femoral fractures. Acta Orthop Scand 1994;65:505–8.

    Article  CAS  PubMed  Google Scholar 

  21. Kolstad K, Adalbert G, Mallmin H, et al. The Wagner revision stem for severe osteolysis. Acta Orthop Scand 1996;67:541–4.

    Article  CAS  PubMed  Google Scholar 

  22. Lewallen DG, Berry DJ. Periprothetic fracture of the femur after total hip arthroplasty. J Bone Joint Surg [Am] 1997;79:1881–90.

    Google Scholar 

  23. Ludwig FJ, Melzer C, Backofen D, et al. Kriterien zur radiologischen Beurteilung zementfreier Hüftendoprothesen am Beispiel des Spotorno-Schaftes. Unfallchirurg 1996;99:750–7.

    Article  CAS  PubMed  Google Scholar 

  24. Moreland JR, Bernstein ML. Femoral revision hip arthroplasty with uncemented, porous-coated stems. Clin Orthop 1995;319:141–50.

    PubMed  Google Scholar 

  25. Ohl MD, Whiteside LA, McCarthy DS, et al. Torsional fixation of a modular femoral hip component. Clin Orthop 1993;287:135–41.

    PubMed  Google Scholar 

  26. Ohsawa S, Fukuda K, Matsushita S, et al. Middle term results of anatomic medullary locking total hip arthroplasty. Arch Orthop Trauma Surg 1998;118:14–20.

    Article  CAS  PubMed  Google Scholar 

  27. Pauschert R, Niethard FU, Schöning B, et al. Letalität nach Frakturen des coxalen Femurendes im fortgeschrittenen Alter. Dtsch Arztebl 1996;93:82–6.

    Google Scholar 

  28. Pilliar RM, Lee JM, Maniatopoulos C. Observation on the effect of movement on bone ingrowth into porous-surfaced implants. Clin Orthop 1986;208:108–13.

    PubMed  Google Scholar 

  29. Siegmeth A, Menth-Chiari W, Wozasek GE, et al. Die periprothetische Femurschaftfraktur. Indikationen und Ergebnisse bei 51 Patienten. Unfallchirurgie 1998;101:901–6.

    Article  CAS  Google Scholar 

  30. Smith JA, Dunn HK, Manaster BJ. Cementless femoral revision arthroplasty. J Arthroplasty 1997;12:194–201.

    Article  CAS  PubMed  Google Scholar 

  31. Spotorno L, Schenk RK, Dietschi C, et al. Unsere Erfahrungen mit nicht-zementierten Prothesen. Orthopdde 1987;16:225–38.

    CAS  Google Scholar 

  32. Urban RM, Jacobs JJ, Gilbert JL, et al. Migration of corrosion products from modular hip prostheses. J Bone Joint Surg [Am] 1994;76:1345–59.

    CAS  Google Scholar 

  33. Whiteside LA, Arima J, White SE, et al. Fixation of the modular total hip femoral component in Cmentless total hip arthroplasty. Clin Orthop 1994;298:184–90.

    PubMed  Google Scholar 

  34. Wilmann G. Fretting bei modular aufgebamen Implantatsystemen. Biomed Techn 1993;38:48–52.

    Article  Google Scholar 

  35. Wirtz DC, Stargardt A, Prescher A, et al. Errors of computerassisted migration analysis in conventional radiographs of femoral hip implants — an experimental study. Arch Orthop Trauma Surg 1999;119:50–6.

    Article  CAS  PubMed  Google Scholar 

  36. Wissing H, Peterson T, Doht A. Risiko und Prognose hüftgelenksnaher Frakturen. Ein Vergleich der Behandlungsergebnisse von Schenkelhals- und pertrochantären Femurfrakturen. Unfallchirurgie 1996;22:74–84.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unfallchirurgie, Chirurgische Klinik und Poliklinik der Universität, Klinikum Großhadern, Marchioninistraße 15, D-81377, München

    Hans-Joachim Andress, Jürgen Landes, Phillip Gierer, Matthias Schürmann & Günter Lob

  2. Institut für Radiologische Diagnostik, Klinikum Großhadern der Ludwig-Maximilians-Universität München, Germany

    Bogdan von Rückmann

  3. Abteilung Unfall- und Wiederherstellungschirurgie, Krankenhaus München-Harlaching, Germany

    Hans Hertlein

Authors
  1. Hans-Joachim Andress
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jürgen Landes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Phillip Gierer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hans Hertlein
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthias Schürmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bogdan von Rückmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Günter Lob
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hans-Joachim Andress.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Andress, HJ., Landes, J., Gierer, P. et al. Modulare Femurendoprothese, bestehend aus einer Kombination von Kopfteil und Marknagel, bei Knochendefektsituationen des Femurs. Unfallchirurgie 25, 267–276 (1999). https://doi.org/10.1007/BF02427873

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02427873

Schlüsselwörter

Key Words

Search

Navigation