Skip to main content

Advertisement

SpringerLink
Log in

Die Arthrodese des Hüftgelenks und ihre Remobilisation

Arthrodesis of the hip and its conversion

  • Weiterbildung · Zertifizierte Fortbildung
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Die Arthrodese des Hüftgelenks als Therapie destruierter und schmerzgeplagter Hüftgelenke wird immer seltener eingesetzt. Dagegen ist die Remobilisation operativ versteifter Hüftgelenke zu einem wichtigen Eingriff in der Orthopädie geworden. Die Indikationen für die operative Hüftarthrodese ergeben sich heute dort, wo zwingende Kontraindikationen gegen die Endoprothetik des Hüftgelenks bestehen oder schwerwiegende muskuläre Defizite die funktionelle Stabilisierung nach einer Totalendoprothesenversorgung nicht erlauben.

Als optimale Stellung eines versteiften Hüftgelenks werden für die Flexion 10–25°, für die Rotationsposition 0–15° Außendrehung, für die Abduktion 0–10° und für die Adduktion 0–6° empfohlen. Zur sofortigen funktionellen Mobilisation des Patienten wird eine stabile Osteosynthese angestrebt. Gangstörungen und vermehrte Belastung der Nachbargelenke an Wirbelsäule, Knie- und kontralateralem Hüftgelenk erzwingen häufig die Remobilisation des Hüftgelenks, die Primärtechnik muss deswegen die funktionsfähige, hüftstabilisierende Muskulatur und ihre Kraftträger erhalten.

Abstract

Arthrodesis of the hip used to be an important means of treating painful and damaged hips. Increasing experiences in total hip replacement have led to restrictive indications for arthrodesis and to more and more total hip arthroplasty. Hip arthrodesis has limited indications today. It remains the treatment of choice in deteriorated, painful hip joints, especially in the case of contraindications and severe muscular deficits. The best position of the fused hip is 10 to 25° flexion, 0 to 15° external rotation, 0 to 10° abduction or 0 to 6° adduction. The aim of the operation is a stable osteosynthesis which allows early mobilisation of the patient. Disturbances in walking patterns, mechanical overloading of neighbouring joints, such as the lumbar spine, ipsilateral knee or contralateral hip, often support a conversion from arthrodesis to total hip arthroplasty. The aim of the primary operation, therefore, is the preservation of the stabilizing pelvitrochanteric muscles and their insertions.

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

Abb. 1 a
Abb. 2 a
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8 a

Literatur

  1. Ahlback SO, Lindahl O (1966) Hip arthrodesis. The connection between function and position. Acta Orthop Scand 37: 77–87

    CAS  PubMed  Google Scholar 

  2. Albee FH (1908) Arthritis deformans of the hip; report of a new operation. JAMA 50: 1553–1554

    Google Scholar 

  3. Albert E (1882) Einige Fälle von künstlicher Ankylosebildung an paralytischen Gliedmaßen. Wien Med Presse 23: 725–728

    Google Scholar 

  4. Altchek M (1975) Is hip fusion ever needed today, and, if so, how can it be done? Orthop Rev 4: 23–28

    Google Scholar 

  5. Alvik I (1962) Arthrodesis of the hip. A method allowing weightbearing and walking postoperatively. Acta Orthop Scand 32: 451–456

    CAS  PubMed  Google Scholar 

  6. Amstutz HC, Sakai DN (1975) Total joint replacement for ankylosed hips. Indications, technique, and preliminary results. J Bone Joint Surg Am 57: 619–25

    CAS  PubMed  Google Scholar 

  7. Attarian DE, Southworth S (1995) Conversion of hip arthrodesis to total joint arthroplasty. Contemp Orthop. 30: 37–42

    Google Scholar 

  8. Axer A (1961) Compression arthrodesis of the hip joint. A preliminary report. J Bone Joint Surg Am 43: 492–504

    Google Scholar 

  9. Barmada R, Abraham E, Ray RD. Hip fusion utilizing the cobra head plate. J Bone Joint Surg Am 1976 Jun;58(4): 541–544

  10. Barnhardt T, Stiehl JB (1996) Hip fusion in young adults. Orthopedics 19: 303–306

    CAS  PubMed  Google Scholar 

  11. Baumann F, Behr O (1969) Electromyographic studies of the hip muscle following arthrodesis. Arch Orthop Unfallchir 66: 1–17

    CAS  PubMed  Google Scholar 

  12. Beauchamp CP, Duncan CP, McGraw RW (1985) Don’t throw away the reamers. A new technique of hip arthrodesis. J Bone Joint Surg Br 67: 330

    Google Scholar 

  13. Benaroch TE, Richards BS, Haideri N, Smith C (1996) Intermediate follow-up of a simple method of hip arthrodesis in adolescent patients. J Pediatr Orthop. 16: 30–36

    Google Scholar 

  14. Besser MI (1982) A muscle transfer to replace absent abductors in the conversion of a fused hip to a total hip arthroplasty. Clin Orthop 162: 173–174

    PubMed  Google Scholar 

  15. Blasier RB, Holmes JR (1990) Intraoperative positioning for arthrodesis of the hip with the double beanbag technique. J Bone Joint Surg Am 72: 766–769

    CAS  PubMed  Google Scholar 

  16. Blietz R, Borgmann F (1967) Pressure osteosynthesis of the hip in loss of the coxal femur end. Arch Orthop Unfallchir 62: 23–28

    CAS  PubMed  Google Scholar 

  17. Breitenfelder J (1975) Electromyographic examinations of the gluteal and adductor muscles after arthrodesis of the hip. Arch Orthop Unfallchir 83: 279–287

    CAS  PubMed  Google Scholar 

  18. Brewster RC, Coventry MB, Johnson EW Jr (1975) Conversion of the arthrodesed hip to a total hip arthroplasty. J Bone Joint Surg Am 57: 27–30

    CAS  PubMed  Google Scholar 

  19. Brien WW, Golz RJ, Kuschner SH, Brien EW, Wiss DA (1994) Hip joint arthrodesis utilizing anterior compression plate fixation. J Arthroplasty. 9: 171–176

    Google Scholar 

  20. Brittain HA (1941) Ischiofemoral arthrodesis. J Bone Joint Surg Br 28: 93–104

    Google Scholar 

  21. Burne BH (1939) Fixation of the osteoarthritic hip by nailing. Lancet 236: 978–982

    Article  Google Scholar 

  22. Callaghan JJ, Brand RA, Pedersen DR (1985) Hip arthrodesis. A long-term follow-up. J Bone Joint Surg Am 67: 1328–1335

    CAS  PubMed  Google Scholar 

  23. Carter PJ, Wickstrom J (1971) Arthrodesis of the hip: an assessment of results in one hundred patients. South Med J. 64: 451–458

    Google Scholar 

  24. Chan KP, Shin JS (1968) Brittain ischiofemoral arthrodesis for tuberculosis of the hip. An analysis of seventy-six cases. J Bone Joint Surg Am 50: 1341–1352

    CAS  PubMed  Google Scholar 

  25. Charnley J (1956) Treatment of monoarticular arthritis of the hip by central dislocation operation. J Bone Joint Surg Br 38: 592–593

    Google Scholar 

  26. Davis JB (1954) The muscle- pedicle bone graft in hip fusion. J Bone Joint Surg Am 36: 790–779

    Google Scholar 

  27. DePalma AF, Fenlin JM Jr (1966) Arthrodesis of the hip with intramedullary fixation. Clin Orthop 48: 191–207

    CAS  PubMed  Google Scholar 

  28. Duncan CP, Spangehl M, Beauchamp C, McGraw R (1995) Hip arthrodesis: an important option for advanced disease in the young adult. Can J Surg 38 (Suppl 1): 39–45

    PubMed  Google Scholar 

  29. Dupont JA, Charnley J (1972) Low-friction arthroplasty of the hip for the failures of previous operations. J Bone Joint Surg Br 54: 77–87

    CAS  PubMed  Google Scholar 

  30. Farkas A (1939) A new operative treatment of tuberculosis coxitis in children. J Bone Joint Surg Br 21: 323–329

    Google Scholar 

  31. Fulkerson JP (1977) Arthrodesis for disabling hip pain in children and adolescents. Clin Orthop 128: 296–302

    PubMed  Google Scholar 

  32. Ganz R, Ruter A (1973) Total prosthesis following arthrodesis of the hip. Z Orthop Ihre Grenzgeb 111: 433–435

    CAS  PubMed  Google Scholar 

  33. Gardiner TB (1962) Nail and graft arthrodesis of the hip. J Bone Joint Surg Br 44: 588–594

    Google Scholar 

  34. Garvin KL, Pellicci PM, Windsor RE, Conrad EU, Insall JN, Salvati EA (1989) Contralateral total hip arthroplasty or ipsilateral total knee arthroplasty in patients who have a long-standing fusion of the hip. J Bone Joint Surg Am 71: 1355–1362

    CAS  PubMed  Google Scholar 

  35. Gertsch R (1966) Arthrodesis of the hip joint with cross-plate and pelvic osteotomy. Helv Chir Acta 33: 216–221

    CAS  PubMed  Google Scholar 

  36. Gordes W (1970) Experience with the technic of Axer-Viernstein’s hip arthrodesis. Arch Orthop Unfallchir 67: 355–366

    CAS  PubMed  Google Scholar 

  37. Gore DR, Murray MP, Sepic SB, Gardner GM (1975) Walking patterns of men with unilateral surgical hip fusion. J Bone Joint Surg Am 57: 759–765

    CAS  PubMed  Google Scholar 

  38. Hanslik L, Friedebold G (1970) Indication for hip arthrodesis after development of stable alloarthroplasties. Arch Orthop Unfallchir 68: 325–342

    CAS  PubMed  Google Scholar 

  39. Hardinge K, Murphy JC, Frenyo S (1986) Conversion of hip fusion to Charnley low-friction arthroplasty. Clin Orthop 211: 173–179

    PubMed  Google Scholar 

  40. Hardinge K, Williams D, Etienne A, MacKenzie D, Charnley J (1977) Conversion of fused hips to low friction arthroplasty. J Bone Joint Surg Br 59: 385–392

    Google Scholar 

  41. Hass J (1922) Extraartikuläre Ankylosierung der Hüfte. Zentralbl Chir 83: 1466–1467

    Google Scholar 

  42. Hordegen KM, Tonnis D (1970) Influence of hip-arthrodesis on the spine. Arch Orthop Unfallchir 69: 97–113

    CAS  PubMed  Google Scholar 

  43. Kempf I, Jenny JY (1991) Total prosthesis after ankylosis of the hip joint. Report of 22 cases. Int Orthop15: 239–243

    Google Scholar 

  44. Kilgus DJ, Amstutz HC, Wolgin MA, Dorey FJ (1990) Joint replacement for ankylosed hips. J Bone Joint Surg Am 72: 45–54

    CAS  PubMed  Google Scholar 

  45. Kostuik J, Alexander D (1984) Arthrodesis for failed arthroplasty of the hip. Clin Orthop 188: 173–182

    PubMed  Google Scholar 

  46. Kreder HJ, Williams JI, Jaglal S, Axcell T, Stephen D (1999) A population study in the Province of Ontario of the complications after conversion of hip or knee arthrodesis to total joint replacement. Can J Surg 42: 433–439

    CAS  PubMed  Google Scholar 

  47. Kummer B (1996) Biomechanics of arthrodesis of the,major joints of the extremities. Orthopäde 25: 99–103

    Google Scholar 

  48. Küntscher G (1953) Die Technik der „geschlossenen“ Hüftarthrodese. Chirurg 24: 404–410

    Google Scholar 

  49. Lam SJS (1986) Arthrodesis of the hip. With special reference to early mobilisation without external splintage. J Bone Joint Surg Br 50: 14–23

    Google Scholar 

  50. Lange M (1958) Arthrodesis of the hip. Review of a series of more than five hundred cases. J Int Coll Surg 29: 638–643

    CAS  PubMed  Google Scholar 

  51. Liechti R (1978) Hip arthrodesis and associated problems, Springer, Berlin Heidelberg New York

  52. Lindahl O (1966) Hip-joint arthrodesis: to find the best position. Acta Orthop Scand 37: 317–327

    CAS  PubMed  Google Scholar 

  53. Lipscomp PR, McCaslin (1961) Arthrodesis of the hip. Review of 371 cases. J Bone Joint Surg Am 43: 923–938

    Google Scholar 

  54. Lubahn JD, Evarts CM, Feltner JB (1980) Conversion of ankylosed hips to total hip arthroplasty. Clin Orthop 153: 146–152

    PubMed  Google Scholar 

  55. Magyar A, Gschwend N (1989) Total prosthesis implantation in the arthritic hip. Orthopäde 18: 493–497

    Google Scholar 

  56. Matta JM, Siebenrock KA, Gautier E, Mehne D, Ganz R (1997) Hip fusion through an anterior approach with the use of a ventral plate. Clin Orthop 337: 129–139

    PubMed  Google Scholar 

  57. McKee GK (1957) Arthrodesis of the hip with a lag- srew. J Bone Joint Surg Br 39: 477–486

    Google Scholar 

  58. Morris JB (1966) Charnley compression arthrodesis of the hip. J Bone Joint Surg Br 48: 260–279

    CAS  PubMed  Google Scholar 

  59. Müller ME, Allgöwer M, Schneider R, Willenegger H (1977) Manual der Osteosynthese. Springer, Berlin Heidelberg New York

  60. Murrell GA, Fitch RD (1994) Hip fusion in young adults. Using a medial displacement osteotomy and cobra plate. Clin Orthop 300: 147–154

    PubMed  Google Scholar 

  61. Nötzli HP, Klaue K, Ganz R (1994) Verbleibende Indikation und Resultate der Hüftarthrodese. In: Stuhler T (Hrsg) Arthrodesen. Thieme, Stuttgart

  62. Onji Y, Kurata Y, Kido H (1965) A new method of hip fusion using an intramedullary nail. J Bone Joint Surg Br 47: 690–693

    CAS  PubMed  Google Scholar 

  63. Padovani P, Joly JP (1951) Résultats éloignés de 308 arthrodéses de hanche. Rev Chir Orthop 47: 83–89

    Google Scholar 

  64. Panagiotopoulos KP, Robbins GM, Masri BA, Duncan CP (2001) Conversion of hip arthrodesis to total hip arthroplasty. Instr Course Lect 50: 297–305

    CAS  PubMed  Google Scholar 

  65. Pellegrini V (1990) Arthrodesis of the hip. In. Evarts CM (ed.): Surgergy of the musculoskeletal system, 2nd edn. Churchill Livingstone, New York, pp 2859–2882

  66. Perugia L, Santori FS, Mancini A, Manili M, Falez F (1992) Conversion of the arthrodesed hip to a total hip arthroplasty. Indications and limitations. Ital J Orthop Traumatol 18: 145–153

    CAS  PubMed  Google Scholar 

  67. Price CT, Lovell WW (1980) Thompson arthrodesis of the hip in children. J Bone Joint Surg Am 62: 1118–1123

    CAS  PubMed  Google Scholar 

  68. Ranawat CS, Jordan LR, Wilson PD Jr (1971) A technique of muscle- pedicle bone graft in hip arthrodesis. A report of its use in ten cases. J Bone Joint Surg Am 53: 925–934

    CAS  PubMed  Google Scholar 

  69. Reikeras O, Bjerkreim I, Gundersson R (1995) Total hip arthroplasty for arthrodesed hips. 5- to 13-year results. J Arthroplasty 10: 529–531

    CAS  PubMed  Google Scholar 

  70. Rittmeister M, Starker M, Zichner L (2000) Hip and knee replacement after longstanding hip arthrodesis. Clin Orthop 371: 136–145

    Article  PubMed  Google Scholar 

  71. Roberts CS, Fetto JF (1990) Functional outcome of hip fusion in the young patient. Follow-up study of 10 patients. J Arthroplasty 5: 89–96

    CAS  PubMed  Google Scholar 

  72. Romness DW, Morrey BF (1992) Total knee arthroplasty in patients with prior ipsilateral hip fusion. J Arthroplasty 7: 63–70

    CAS  PubMed  Google Scholar 

  73. Schäfer D, Dick W, Morscher E (2000) Total hip arthroplasty after arthrodesis of the hip joint. Arch Orthop Trauma Surg 120: 176–178

    Article  PubMed  Google Scholar 

  74. Schneider CA, Brooks AL, Wagner M, McFayden B, Shiavi R (1985) Positioning the arthrodesed hip. Orthop rev. 14: 424–428

    Google Scholar 

  75. Schneider R (1976) Die Arthrodese des Hüftgelenkes mit Kobraplatte und Beckenosteotomie. Huber, Bern

  76. Schneider R (1974) Hip arthrodesis with the Cobra plate and pelvic osteotomy. Reconst Surg Traumatol. 14: 1–37

    Google Scholar 

  77. Schotten P (1966) Arthrodesis of the hip joint with a spring ring screw in combination with intratrochanteral osteotomy and plumbage of the hip joint. Arch Orthop Unfallchir 60: 274–280

    CAS  PubMed  Google Scholar 

  78. Sofue M, Kono S, Kawaji W, Homma M (1989) Long term results of arthrodesis for severe osteoarthritis of the hip in young adults. Int Orthop 13: 129–133

    CAS  PubMed  Google Scholar 

  79. Somerville EW (1969) Two-nail fixation of the hip. J Bone Joint Surg Br 51: 648–653

    CAS  PubMed  Google Scholar 

  80. Spangehl MJ, Younger AS, Masri BA, Duncan CP (1998) Diagnosis of infection following total hip arthroplasty. Instr Course Lect 47: 285–295

    CAS  PubMed  Google Scholar 

  81. Sponseller PD, McBeath AA, Perpich M (1984) Hip arthrodesis in young patients. A long-term follow-up study. J Bone Joint Surg Am 66: 853–859

    CAS  PubMed  Google Scholar 

  82. Stewart MJ, Coker TP Jr (1969) Arthrodesis of the hip. A review of 109 patients. Clin Orthop 62: 136–150

    CAS  PubMed  Google Scholar 

  83. Stinchfield FE, Cavallaro WU (1950) Arthrodesis of the hip joint. A follow-up study. J Bone Joint Surg Am 32: 48–58

    Google Scholar 

  84. Strathy GM, Fitzgerald RH Jr (1988) Total hip arthroplasty in the ankylosed hip. A ten-year follow-up. J Bone Joint Surg Am 70: 963–966

    CAS  PubMed  Google Scholar 

  85. Thompson FR (1956) Combined hip fusion and subtrochanteric osteotomy allowing early ambulation. J Bone Joint Surg Am 38: 13–22

    Google Scholar 

  86. Wagner H, Wagner M (1994) Rekonstruktive Operationen an der Hüfte. In: Bauer R, Kerschbaumer F, Poisel S (Hrsg.) Orthopädische Operationslehre, Bd II/1. Thieme, Stuttgart

  87. Wagner M, Wagner H (1996) Hip joint arthrodesis using the cobra plate. Indication, technique, outcome. Orthopäde 25: 129–139

  88. Wagner M (1994) Die Remobilisation des Hüftgelenkes nach Arthrodese- Indikation, Technik, Ergebnisse. In: Stuhler T (Hrsg) Arthrodesen. Thieme, Stuttgart

  89. Waters RL, Barnes G, Husserl T, Silver L, Liss R (1988) Comparable energy expenditure after arthrodesis of the hip and ankle. J Bone Joint Surg Am 70: 1032–1037

    CAS  PubMed  Google Scholar 

  90. Watson- Jones R, Robinson WC (1956) Arthrodesis of the osteoarthritic hip joint. J Bone Joint Surg Br 38: 353–377

    Google Scholar 

  91. Weber BG (1973) Hip arthrodesis. In: Tronzo G (eds) Surgery of the hip. Lea & Febiger, Philadelphia

  92. White RE Jr (1990) Arthrodesis of the hip. Proceedings of the twelth open scientific meeting of the hip society. Mosby, St. Louis, pp 54–67

  93. Wölfel AR, Walther M, Rader C, Beck H (2000) Endoprosthetic management of patients with hip arthrodesis. Z Orthop Ihre Grenzgeb 138: 318–323

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Orthopädische Klinik Wichernhaus, Krankenhaus Rummelsberg

    G. Zeiler & A. Schuh

  2. Orthopädische Klinik Wichernhaus, Krankenhaus Rummelsberg, Rummelsberg 71, 90592, Schwarzenbruck

    G. Zeiler

Authors
  1. G. Zeiler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Schuh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Zeiler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zeiler, G., Schuh, A. Die Arthrodese des Hüftgelenks und ihre Remobilisation. Orthopäde 33, 939–957 (2004). https://doi.org/10.1007/s00132-004-0697-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-004-0697-1

Schlüsselwörter

Keywords

Search

Navigation