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Koinzidenz von Hüftdysplasie und femuroazetabulärem Impingement

Klinisches Bild und simultane operative Korrektur

Combined hip-dysplasia and femuroacetabular impingement

Diagnosis and simultaneous surgical treatment

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Zusammenfassung

Während die Diagnose und Behandlungsstrategie von Hüftdysplasie und femuroazetabulärem Impingement als jeweils getrennt auftretendes Erkrankungsbild mittlerweile recht standardisiert ist, gibt es noch kaum Empfehlungen zum adäquaten Vorgehen, wenn beide Probleme gleichzeitig bestehen.

Ein diagnostischer Algorithmus und eine neue Operationstechnik mit simultaner Durchführung von periazetabulärer Osteotomie und arthroskopisch assistierter Offsetverbesserung über einen weniger invasiven Zugang wird vorgestellt. Kurzfristige Behandlungsergebnisse einer Pilotstudie von bisher 19 damit behandelten Patienten zeigen, dass eine effektive Verbesserung der radiologischen Deformität und klinischer Beschwerden möglich ist.

Abstract

Developmental Dysplasia of the hip as well as femuroacetabular impingement are recognized causes of hip pain and degenerative disorders. While accepted treatment recommendations for both entities currently exist, there are no standardised approaches published for the management of combined lesions.

We therefore present an algorithm of diagnosis and simultaneous surgical treatment based on a combination of periacetabular osteotomy and arthroscopically-assisted minimally invasive anterior osteochondroplasty. Short-term treatment results of 19 patients show an effective improvement of clinical symtoms and radiographic deformity.

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Literatur

  1. Beck M, Leunig M, Parvizi J et al. (2004) Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res 418: 67–73

    Article  PubMed  Google Scholar 

  2. Bernstein P, Thielemann F, Günther K-P (2007) A modification of periacetabular osteotomy using a two-incision approach. Open Orthop J 1: 18–13

    Google Scholar 

  3. Clohisy JC, McClure JT (2005) Treatment of anterior femoroacetabular impingement with combined hip arthroscopy and limited anterior decompression. Iowa Orthop J 25: 164–171

    PubMed  Google Scholar 

  4. Dorrell JH, Catterall A (1986) The torn acetabular labrum. J Bone Joint Surg Br 68: 400–403

    CAS  PubMed  Google Scholar 

  5. Espinosa N, Rothenfluh DA, Beck M et al. (2006) Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am 88–5: 925–935

  6. Ganz R, Klaue K, Vinh TS, Mast JW (1988) A new periacetabular osteotomy for the treatment of hip dysplasias, technique and preliminary results. Clin Orthop 232: 26–36

    PubMed  Google Scholar 

  7. Ganz R, Gill TJ, Gautier E et al. (2001) Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 83(8): 1119–1124

    Article  CAS  PubMed  Google Scholar 

  8. Ganz R, Parvizi J, Beck M et al. (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417: 112–120

    PubMed  Google Scholar 

  9. Günther KP, Stürmer T, Sauerland S et al. (1998) Prevalence of generalised osteoarthritis in patients with advanced hip and knee osteoarthritis: the Ulm Osteoarthritis Study. Ann Rheum Dis 57(12): 717–723

    PubMed  Google Scholar 

  10. Günther KP, Stürmer T, Trepte CT et al. (1999) Incidence of joint-specific risk factors in patients with advanced cox- and gonarthroses in the Ulm Osteoarthrosis Study. Z Orthop Ihre Grenzgeb 137(6): 468

    PubMed  Google Scholar 

  11. Günther KP, Hartmann A, Aikele P et al. (2007) Large femoral neck cysts in association with femoroacetabular impingement. J Bone Joint Surg Am 89: 863–870

    Article  PubMed  Google Scholar 

  12. Ziegler J, Amlang, Bottesi M et al. (2007) Results for endoprosthetic care in patients younger than 50 years. Orthopäde 36(4): 325–336

    Article  CAS  PubMed  Google Scholar 

  13. Hart WJ, Roberts AR, Evans GA (2006) Triple pelvic osteotomy for the management of painful developmental hip dysplasia in the young adult. Hip Int 16: 185–190

    CAS  PubMed  Google Scholar 

  14. Hartmann A, Günther KP (2008) Arthroscopically assisted treatment of femoroacetabular impingement by an anterior mini-open decompression: surgical procedure and early clinical results. Arch Orthop Trauma Surg (im Druck)

  15. Klaue K, Durnin CW, Ganz R (1991) The acetabular rim syndrome, a clinical presentation of dysplasia of the hip. J Bone Joint Surg Br 73(3): 423–429

    CAS  PubMed  Google Scholar 

  16. Lehman WB, Mohaideen A, Madan S et al. (2004) Surgical technique for an almost percutaneous triple pelvic osteotomy for femoral head coverage in children 6–14 years of age. J Pediatr Orthop B 13: 57–62

    Article  PubMed  Google Scholar 

  17. Lequesne M, de Séze S (1961) Le faux profil du basin, nouvelle incedence radiographique pour l‚etude de la hanche, son utilité dans le dysplasies et les differentes coxopathies. Rev Rheum 28: 643–52

    CAS  Google Scholar 

  18. Leunig M, Siebenrock KA, Ganz R, (2001) Rationale of periacetabular osteotomy and background work. J Bone Joint Surg Am 83: 438–48

    Google Scholar 

  19. Leunig M, Beck M, Dora C, Ganz R. (2006) Femoroacetabular impingement: trigger for the development of coxarthrosis. Orthopade 35(1): 77–84

    Article  CAS  PubMed  Google Scholar 

  20. MacDonald SJ, Garbuz D, Ganz R (1997) Clinical evaluation of the symptomatic young adult hip. Sem Arthroplasty 8: 3–9

    Google Scholar 

  21. Millis MB, Murphy SB (1998) The Boston concept. peri-acetabular osteotomy with simultaneous arthrotomy via direct anterior approach. Orthopäde 27(11): 751–758

    CAS  PubMed  Google Scholar 

  22. Murphy SB, Kijewski PK, Harless A, Millis MB (1991) Acetabular dysplasia in the adolescent and young adult. Clin Orthop 261: 214–223

    Google Scholar 

  23. Murphy S, Tannast M, Kim YJ et al. (2004) Debridement of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clin Orthop Relat Res 429: 178–181

    Article  PubMed  Google Scholar 

  24. Murray RO (1965) The aetiology of primary osteoarthritis of the hip. Br J Radiol 38: 810–824

    Article  CAS  PubMed  Google Scholar 

  25. Myers SR, Eijer H, Ganz R (1999) Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop 363: 93–99

    PubMed  Google Scholar 

  26. Nötzli HP, Wyss TF, Stoecklin CH et al. (2002) The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 84(4): 556–560

    Article  PubMed  Google Scholar 

  27. Pajarinen J, Hirvensalo E (2003) Two-incision technique for rotational acetabular osteotomy. Acta Orthop Scand 74: 133–139

    Article  PubMed  Google Scholar 

  28. Peters CL, Erickson JA, Hines JL (2006) Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center. J Bone Joint Surg Am 88: 1920–1926

    Article  PubMed  Google Scholar 

  29. Philippon MJ, Schenker ML (2006) Arthroscopy for the treatment of femoroacetabular impingement in the athlete. Clin Sports Med 25(2): 299–308

    Article  PubMed  Google Scholar 

  30. Philippon MJ, Schenker ML (2006) A new method for acetabular rim trimming and labral repair. Clin Sports Med 25(2): 293–297

    Article  PubMed  Google Scholar 

  31. Reynolds D, Lucas J, Klaue K (1999) Retroversion of the Acetabulum, a cause of hip pain. J Bone Joint Surg Br 81: 281–288

    Article  CAS  PubMed  Google Scholar 

  32. Sadri H, Menetrey J, Kraus E, Hoffmeyer P (2006) Arthroscopic treatment of femoroacetabular impingement. Arthroskopie 19: 67–74

    Article  Google Scholar 

  33. Siebenbrock KA, Leunig M, Ganz R (2001) Periacetabular osteotomy: the bernese experience. J Bone Joint Surg Am 83: 449–455

    Google Scholar 

  34. Siebenrock KA, Schoeniger R, Ganz R (2003) Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am 85(2): 278–286

    PubMed  Google Scholar 

  35. Stulberg SD, Cordell LD, Harris WH et al. (1975) Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. Proceedings of the Third Open Scientific Meeting of The Hip Society. Mosby, St. Louis, pp 212–228

  36. Tanzer M, Noiseux N (2004) Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res 429: 170–177

    Article  PubMed  Google Scholar 

  37. Tschauner C (2007) Die biomechanische Koxarthrose des jungen Erwachsenen – Prävention und gelenkerhaltende Therapieoptionen. Z Orthop Unfall 145(3): 369–386

    Article  PubMed  Google Scholar 

  38. Tönnis D (1978) The prearthrotic deformity as origin of coxarthrosis, radiographic measurements and their value in the prognosis. Z Orthop Ihre Grenzgeb 116: 444–446

    PubMed  Google Scholar 

  39. Tönnis D (1987) Congenital dysplasia and dislocation of the hip in children and adults. Springer, Berlin Heidelberg New York, pp 113–380

  40. Tönnis D, Arning A, Bloch M et al. (1994) Triple pelvic osteotomy. J Pedatric Orthop Part B 3: 54–67

    Google Scholar 

  41. Wall EJ, Kolata RJ, Roy DR et al. (2001) Endoscopic pelvic osteotomy for the treatment of hip dysplasia. J American Academy Orthop Surg 9: 156–150

    Google Scholar 

  42. Wettstein M, Dienst M (2006) Hip arthroscopy for femoroacetabular impingement. Orthopade 35(1): 85–93

    Article  CAS  PubMed  Google Scholar 

  43. Wiberg G (1939) Studies on dysplastic acetabula and congenital subluxation of the hip joint, with special reference to the complication of osteoarthritis, parts I-IV. Acta Chir Scand 58(Suppl): 7–38

    Google Scholar 

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Untersützung des BMBF mit Verbundmitteln (orthoMIT). Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität, Anstalt des öffentlichen Rechts des Freistaates Sachsen, Fetscherstraße 74, 01307, Dresden, Deutschland

    K.-P. Günther, F. Thielemann, A. Hartmann & P. Bernstein

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  1. K.-P. Günther
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  2. F. Thielemann
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  3. A. Hartmann
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  4. P. Bernstein
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Correspondence to K.-P. Günther.

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Die vorliegende Arbeit wurde mit Projektmitteln des Verbundvorhabens „orthoMIT“ im Rahmen der BMBF-Leitvision „Schonendes Operieren mit innovativer Technik“ (SOMIT) unterstützt.

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Günther, KP., Thielemann, F., Hartmann, A. et al. Koinzidenz von Hüftdysplasie und femuroazetabulärem Impingement. Orthopäde 37, 577–586 (2008). https://doi.org/10.1007/s00132-008-1241-5

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