Das Laufverhalten von Patienten mit künstlichem Hüftgelenkersatz und dessen Folgeerscheinungen: Ein systematisches Review zum aktuellen Forschungsstand

Zusammenfassung

Laufen wird als Sportart mit hoher Stoßbelastung eingestuft und Patienten mit einem künstlichen Hüftgelenk nicht empfohlen. Entgegen dieser Empfehlungen kehren einige Läufer nach einer Operation dennoch zum Laufsport zurück. Es sind wissenschaftliche Erkenntnisse zum allgemeinen postoperativen Sportverhalten vorhanden, allerdings kaum Ergebnisse zum Laufen im Speziellen. Auf Basis der aktuellen Datenlage soll dieses Review die Fragen bearbeiten, (1) wie hoch der Läuferanteil unter den Patienten ist, (2) welche Trainingsparameter festzustellen sind und (3) ob negative Folgeerscheinungen für die Prothesenhaltbarkeit auftreten. In PubMed wurde mit einer spezifischen MeSH-Term-Suche gearbeitet. Nach der Analyse von Titel, Abstract und Volltext erfüllten drei von ursprünglich 39 Artikeln die Einschlusskriterien. Postoperativ betrug der Anteil an joggenden Patienten zwischen 3,8 % und 16,3 %. Nur zwei der Studien berichteten von Trainingsparametern: Die wöchentliche Trainingsfrequenz lag bei 3,5–4-Mal pro Woche mit Läufen zwischen 14,4–28,4 km, 116–186 Minuten und 7,7–9,2 km/h. Ein Patient nahm sogar an einem Marathon über 42,5 km teil. In der eingeschlossenen Literatur wurde in keinem Fall von Prothesenlockerung oder erhöhter Abnutzung berichtet. Positiv ist, dass die Läufer eine bessere körperliche Funktion und weniger Schmerzen zeigten als nicht laufende Hüftprothesen-Patienten. Es bleibt zu beachten, dass die eingeschlossene Literatur keine ausreichende Evidenz über Langzeiteffekte auf Hüftgelenkersatz durch Laufen liefert. Erstens ist die Anzahl an Studien mit hoher Qualität gering und zweitens lagen die beobachteten Follow-Up-Längen bei 3,9 Jahren und sind folglich unzulänglich kurz. Neben Longitudinalstudien würde eine biomechanische Untersuchung helfen, die Empfehlungen zum Laufen nach Hüftgelenkersatz weiterzuentwickeln.

Summary

Running is classified as a high-impact sport and in general guidelines for hip arthroplasty not recommended after hip replacement. Despite these recommendations, numerous runners return to their sport after hip arthroplasty. Investigations about sport after hip arthroplasty have usually a broad focus and running in particular is not well investigated. Therefore, the purpose of this review was (1) to quantify the return to running after hip arthroplasty, (2) to document applied training parameters (e. g. weekly exposure, milages), and (3) if there are negative consequences for the prosthesis durability following running. A PubMed search was performed using specific MeSH term search. After scanning title, abstract, and full-text, from the original 39 papers only three papers met the inclusion criteria. The range of patients who returned to running post-operatively was between 3.8 % and 16.3 %. Only two studies reported general running parameters: weekly exposure 3.5–4.0 times per week, with runs of 14.4–28.4 km, 116–186 mins, and 7.7–9.2 km/h. One triathlete even participated in a marathon over 42.5 km. In these literature findings there were no reports about loosening of the hip replacement or excessive wear. On the positive side, runners were reported to show better physical function and less pain than arthroplasty patients who did not participate in recreational running. It needs to be kept in mind, however, that the included literature does not provide sufficient evidence on long-term effects on hip replacements caused by running. First, the number of high-quality studies is very low and secondly, studied follow-up periods were in the order of 3.9 years, and thus, insufficiently short. Besides longitudinal investigations, biomechanical running analyses would help to refine recommendations regarding running after hip arthroplasty.

Schlüsselwörter

Künstliches Hüftgelenk - Hüft-Totalendoprothese - Laufsport - Joggen

Keywords

Hip replacement - total hip arthroplasty - running performance - jogging

• Literatur

• 1 Huch K. Sports activities 5 years after total knee or hip arthroplasty: the Ulm Osteoarthritis Study. Annals of the Rheumatic Diseases 2005; 64 (12) 1715-1720
• 2 Vogel LA, Carotenuto G, Basti JJ, Levine WN. Physical Activity After Total Joint Arthroplasty. Sports Health: A Multidisciplinary Approach 2011; 3 (05) 441-450
• 3 Ollivier M, Frey S, Parratte S, Flecher X, Argenson J. Does Impact Sport Activity Influence Total Hip Arthroplasty Durability?. Clin Orthop Relat Res 2012; 470 (11) 3060-3066
• 4 Klein GR, Levine BR, Hozack WJ. et al. Return to Athletic Activity after Total Hip Arthroplasty. The Journal of Arthroplasty 2007; 22 (02) 171-175
• 5 Swanson EA, Schmalzried TP, Dorey FJ. Activity recommendations after total hip and knee arthroplasty: a survey of the American Association for Hip and Knee Surgeons. The Journal of Arthroplasty 2009; 24 6 Suppl 120-126
• 6 Schmalzried TPI, Shepherd EF, Dorey FJ. et al. The John Charnley Award. Wear is a function of use, not time. Clin Orthop Relat Res 2000; 381: 36-46
• 7 Girard J, Miletic B, Deny A. et al. Can patients return to high-impact physical activities after hip resurfacing? A prospective study. International Orthopaedics (SICOT) 2013; 37 (06) 1019-1024
• 8 Malcolm TL, Szubski CR, Nowacki AS. et al. Activity Levels and Functional Outcomes of Young Patients Undergoing Total Hip Arthroplasty. Orthopedics 2014; 37 (11) e983-e992
• 9 Schwachmeyer V, Damm P, Bender A. et al. In vivo hip joint loading during post-operative physiotherapeutic exercises. PLoS ONE 2013; 8 (10) e77807
• 10 Jassim SS, Douglas SL, Haddad FS. Athletic activity after lower limb arthroplasty: a systematic review of current evidence. Bone Joint J 2014; 96-B [phone]
• 11 Abe H, Sakai T, Nishii T. et al. Jogging After Total Hip Arthroplasty. The American Journal of Sports Medicine 2014; 42 (01) 131-137
• 12 Fouilleron N, Wavreille G, Endjah N, Girard J. Running Activity After Hip Resurfacing Arthroplasty: A Prospective Study. The American Journal of Sports Medicine 2012; 40 (04) 889-894
• 13 Haan Rde, Campbell P, Reid S. et al. Metal ion levels in a triathlete with a metal-on-metal resurfacing arthroplasty of the hip. The Journal of bone and joint surgery. British volume 2007; 89 (04) 538-541
• 14 Banerjee M, Bouillon B, Banerjee C. et al. Sports Activity After Total Hip Resurfacing. The American Journal of Sports Medicine 2010; 38 (06) 1229-1236
• 15 Williams DH, Greidanus NV, Masri BA. et al. Predictors of Participation in Sports After Hip and Knee Arthroplasty. Clin Orthop Relat Res 2012; 470 (02) 555-561
• 16 Heiderscheit BC, Chumanov ES, Michalski MP. et al. Effects of step rate manipulation on joint mechanics during running. Medicine and science in sports and exercise 2011; 43 (02) 296-302
• 17 Dubs L, Gschwend N, Munzinger U. Sport after total hip arthroplasty. Arch Orthop Trauma Surg 1983; 101 (03) 161-169
• 18 Majewski M, Widmer KH, Pfister AJ, Friederich NF. Sports and Total Hip Arthroplasty – A Contradiction in Terms? Analysis with a minimum Follow-up of Ten Years. Sports Orthop Traumatol 2014; 30 (04) 359-365
• 19 Chatterji U, Ashworth MJ, Lewis PL, Dobson PJ. Effect of total hip arthroplasty on recreational and sporting activity. ANZ journal of surgery 2004; 74 (06) 446-449
• 20 Kilgus DJM, Dorey FJP, Finerman GA. et al. Patient Activity, Sports Participation, and Impact Loading on the Durability of Cemented Total Hip Replacements. Clinical Orthopaedics & Related Research 1991; 8
• 21 Innmann MM, Weiss S, Andreas F. et al. Sports and physical activity after cementless total hip arthroplasty with a minimum follow-up of 10 years. Scandinavian journal of medicine & science in sports 2015
• 22 van den Bogert AJ, Read L, Nigg BM. An analysis of hip joint loading during walking, running, and skiing. Medicine & Science in Sports & Exercise 1999; 131-142
• 23 Bergmann G, Graichen F, Rohlmann A. et al. Realistic loads for testing hip implants. Bio-medical materials and engineering 2010; 20 (02) 65-75
• 24 Bergmann G, Graichen F, Rohlmann A. et al. Hip joint loading during walking and running, measured in two patients. Journal of Biomechanics 1993; 26 (08) 969-990
• 25 Horstmann T, Listringhaus R, Haase G. et al. Changes in gait patterns and muscle activity following total hip arthroplasty: A six-month follow-up. Clinical Biomechanics 2013; 28 (07) 762-769