Glutealinsuffizienz nach Hüfttotalendoprothese: Diagnostik und Therapieverfahren

Zusammenfassung

Die pelvitrochantäre Insuffizienz nach Hüftprothesenimplantation stellt eine schwerwiegende Komplikation mit gravierenden funktionellen Einschränkungen und einer deutlichen Reduktion der Lebensqualität für den Patienten dar. Häufige Ursachen sind degenerative Rupturen oder zugangsbedingte iatrogene Schädigungen der Mm. gluteus medius und minimus sowie des N. gluteus inferior, Trochanter-major-Frakturen und Probleme in der Rekonstruktion der Beinlänge und des femoroazetabulären Offsets. Mit einer standardisierten Diagnostik aus klinischer Untersuchung, konventionellem Röntgen und MRT können die Ursachen der funktionellen Probleme häufig gut eruiert werden. Die Therapie der pelvitrochantären Insuffizienz ist für Patient und Behandler herausfordernd und meist langwierig. Mit einem klaren diagnostischen und therapeutischen Algorithmus und einer guten Aufklärung des Patienten kann es jedoch gelingen, auch in diesem herausfordernden Krankheitsbild gute Behandlungserfolge zu erzielen. Die konservative Therapie mit exzentrischer Dehnung und Muskelkräftigung bildet dabei das Fundament der Behandlung. Im Falle von frustranen Verläufen trotz intensiver konservativer Behandlung stehen unterschiedliche anatomische und extraanatomische operative Rekonstruktionsverfahren zur Verfügung, um Schmerzen zu lindern und die Funktion zu verbessern. Die anatomische Rekonstruktion der glutealen Sehneninsertion kommt bei geringgradiger fettiger Degeneration und moderater Retraktion der Glutealmuskulatur infrage. Bei fortgeschrittenen degenerativen Veränderungen der Mm. gluteus medius und minimus und intaktem M. gluteus maximus kann die Verschiebeplastik nach Whiteside angewandt werden. Für höhergradige Weichteildefekte besteht außerdem die Möglichkeit eines isolierten oder additiven Versatzes des M. vastus lateralis.

Schlüsselwörter

Glutealinsuffizienz - Hüftendoprothetik - Muskelrekonstruktion

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