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Z Orthop Ihre Grenzgeb 2001; 139(3): 221-228
DOI: 10.1055/s-2001-16325
HÜFTENDOPROTHETIK

Georg Thieme Verlag Stuttgart · New York

Thromboembolische Komplikationen bei der Verwendung von Knochenzement in der Hüftendoprothetik - Pathogenese und Prophylaxe

Thromboembolic Complications Related to the Use of Bone Cement during Total Hip Arthroplasty - Pathogenesis and ProphylaxisC.  Heisel1 , M.  Clarius1 , U.  Schneider2 , S.  J.  Breusch1
  • 1Orthopädische Universitätsklinik Heidelberg (Abteilung Orthopädie I: Dir. Prof. Dr. V. Ewerbeck)
  • 2Orthopädische Universitätsklinik der RWTH Aachen (Univ. Prof. Dr. F. U. Niethard)
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Publication History

Publication Date:
31 December 2001 (online)

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Zusammenfassung.

Fragestellung: Die Implantation einer zementierten Hüfttotalendoprothese stellt einen Risikoeingriff dar, bei dem es zu operationsbedingten kardiovaskulären Komplikationen mit Embolisation von Knochenmarkbestandteilen in die Blutbahn kommen kann. Methode: Die vorliegende Arbeit stellt eine Übersicht der relevanten Literatur dar, die zu diesem Thema seit der klinischen Einführung von Knochenzement durch Sir J. Charnley erschienen ist. Ergebnisse und Schlussfolgerungen: Die unterschiedlichen Techniken der Markraumpräparation und insbesondere die Spülung des Knochenlagers mittels pulsierender Druckspülung sind von großer Wichtigkeit, um die Menge des embolischen Markrauminhaltes zu verringern. Die Reinigung des Knochenlagers gewährleistet darüber hinaus eine verbesserte Zementpenetration in die Spongiosa. Moderne Zementiertechniken, die mit einem deutlich erniedrigten Revisionsrisiko verbunden sind, sehen die Verwendung einer gepulsten Druckspülung, den Gebrauch eines intramedullären Markraumstoppers und die Kompression des applizierten Zementes vor. Insbesondere bei Verwendung von Druckzementiertechniken sollte eine ausreichende Markraumdrainage (ggf. Vakuumapplikation) gewährleistet werden, um das Risiko thrombembolischer Komplikationen zu reduzieren. Bei Verwendung von zementfreien Implantaten erscheint die Einschwemmung von embolisch wirksamen Bestandteilen in die Blutbahn geringer. Eine thromboembolische Komplikation kann allerdings auch bei dieser Verankerungstechnik nicht ausgeschlossen werden.

Introduction: Cemented total hip arthroplasty (THA) has to be considered a high-risk procedure with respect to cardiovascular complications. The insertion of cement and prosthesis may lead to intravasation of fat and bone marrow into the circulation. Methods: This article represents a review on the relevant literature about thromboembolic complications associated with the use of bone cement in THA. Results/Discussion: The method of canal preparation and lavage is of paramount importance to reduce the potential embolic load. Additionally, thorough cleaning of the intramedullary cavity (using jet lavage) improves the cement penetration into the bone and increases the shear strength of the bone-cement interface. Modern cementing techniques include the use of high pulsatile lavage, a cement restrictor and cement pressurization. With the application of these techniques a sufficient drainage of the medullary canal should be guaranteed to minimise the risk for thromboembolic complications. During the insertion of cementless implants the intravasation of embolic material seems to be less, but it is likewise possible to have a thromboembolic complication during cementless THA. However, it is not justified as a consequence to use the thromboembolic risk as the main indication for implant choice, in particular as the overall risk of a serious fatal complication is low.

Schlüsselwörter:

Thromboembolie - Knochenzement - Zementiertechnik - alloplastischer Hüftgelenkersatz - Komplikationen

Key words:

thromboembolism - bone cement - cementing technique - total hip arthroplasty - complications

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Dr. med. Christian Heisel

Orthopädische Universitätsklinik Heidelberg

Schlierbacher Landstraße 200 A

69118 Heidelberg

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