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Verlauf der periprothetischen Knochendichte nach Hüfttotalendoprothesenimplantation

Abhängigkeit von Prothesentyp und knöcherner Ausgangssituation

Periprosthetic bone loss after total hip endoprosthesis

Dependence on the type of prosthesis and preoperative bone configuration

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Zusammenfassung

Bei 81 Patienten wurden mittels DEXA die Veränderungen der periprothetischen Knochendichte über einen Zeitraum von 1 Jahr nach Implantation einer zementfreien Hüfttotalendoprothese untersucht. Implantiert wurden 4 Endoprothesentypen (Vision 2000/Duraloc, ALPHA-Fit/ALPHA-Lock Plus, CLS/Allofit, Mayo/Trilogy). Aus den Messungen sollten Hinweise auf den Einfluss des Prothesentyps sowie der knöchernen Ausgangssituation am Femur auf die Reaktion des Knochens gewonnen werden.

Die stärksten Abnahmen der Knochendichte fanden sich bei allen Stieltypen in der Region des Calcar femoris, geringste Veränderungen waren distal sowie medial der Prothesenspitze zu finden. Bei Prothesen mit kürzerem Stiel war die Knochendichteabnahme insgesamt deutlich niedriger als bei Prothesen mit längerem Stiel.

Mit wachsender Prothesengröße wurde bei proximal porös beschichteten Stielen aus Kobaltchrom häufiger eine proximale Atrophie beobachtet, beim Prothesenstiel aus Titanlegierung mit komplett aufgerauter Oberfläche nahm dabei die distale Hypertrophie zu. Ein niedriger präoperativer Kortikalis-Markraum-Index verstärkte bei proximal porös beschichteten Prothesen die proximale Atrophie und führte beim Prothesenstiel mit komplett aufgerauter Oberfläche distal vermehrt zur Hypertrophie ohne proximale Atrophie.

Abstract

The changes of the periprosthetic bone density were examined with DEXA in 81 patients over a period of 1 year after implantation of cementless total hip endoprosthesis. Four types of endoprostheses (Vision 2000/Duraloc, ALPHA-Fit/ALPHA-Lock Plus, CLS/Allofit, Mayo/Trilogy) were implanted. Information on the changes of the periprosthetic bone density depending on the type of the prosthesis and the bony situation at the femur before operation was expected from these measurements.

In all types of stems the strongest reduction of the bone density was found in the region of the calcar femoris, and the smallest changes were found distally and medially of the tip of the prostheses. In the prosthesis with shorter stem the change of the bone density was altogether clearly lower than in prostheses with longer stem.

With increasing size of the prosthesis with proximally porous coating made from cobalt-chrome alloy, proximal atrophy was observed more frequently, whilst in the prosthesis made from titanium alloy with completely rough-blasted surface the distal hypertrophy increased. A low preoperative corticalis-bone marrow index strengthened the proximal atrophy in proximally porously coated prosthesis made from cobalt-chrome alloy and led in the prosthesis with completely rough-blasted surface more often to distal hypertrophy of the bone.

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Authors and Affiliations

  1. Orthopädische Klinik am Waldkrankenhaus „Rudolf-Elle“ gGmbH, Lehrstuhl für Orthopädie, Friedrich-Schiller-Universität Jena, Eisenberg

    A. Roth, K. Sander, A. Sachse, R. Fuhrmann, A. Wagner & R.-A. Venbrocks

  2. Abteilung für Innere Medizin, Kreisspital für das Freiamt, Muri, Schweiz

    G. Richartz

  3. Orthopädische Klinik am Waldkrankenhaus „Rudolf-Elle“ gGmbH, Lehrstuhl für Orthopädie, Friedrich-Schiller-Universität Jena, Klosterlausnitzer Straße 81, 07607, Eisenberg

    A. Roth

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  1. A. Roth
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Roth, A., Richartz, G., Sander, K. et al. Verlauf der periprothetischen Knochendichte nach Hüfttotalendoprothesenimplantation. Orthopäde 34, 334–344 (2005). https://doi.org/10.1007/s00132-005-0773-1

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