Die periprothetische proximale Femurfraktur der Hüfte: Wann ist der Prothesenwechsel unvermeidlich?

Die Zahl der Hüftendoprothesenrevisionen nimmt kontinuierlich zu – eine direkte Folge steigender Primärimplantationen, längerer Standzeiten und einer älter werdenden, zugleich aktiven Patient*innenkohorte. Der Prothesenwechsel im Bereich des proximalen Femurs stellt hierbei eine besondere Herausforderung dar: Der vorliegende Beitrag bietet einen praxisnahen Überblick – von der Diagnostik und Klassifikation über die operative Strategie bis hin zu einer typischen Fallkonstellation – und soll als Leitfaden für die komplexe Versorgung dieser Patient*innen dienen.

Abstract

The number of revision hip arthroplasties is steadily increasing due to rising primary implantations, longer implant survival, and an aging yet active patient population. Revisions involving the proximal femur are particularly challenging, as they require careful differentiation between aseptic loosening, infection, and periprosthetic fracture. Accurate preoperative planning and established classification systems such as the Vancouver and Unified Classification System are critical for therapeutic decision-making. While aseptic loosening can often be managed with modular, diaphyseally anchored revision stems, periprosthetic infections usually demand a two-stage procedure. Vancouver B2/B3 fractures almost invariably require stem revision. Despite technical advances, complication rates remain high, particularly regarding dislocation, infection, and re-revision. This article provides a practice-oriented overview of diagnostics, classification, and surgical strategies, supplemented by representative case examples, and is intended to serve as a guide for the complex management of these patients.

Kernaussagen

• Frühe Infektdiagnostik ist essenziell, da Low-Grade-Infekte leicht übersehen werden.

• Vancouver- und UCS-Klassifikation sind unverzichtbare Werkzeuge zur Therapieplanung.

• Aseptische Revisionen: einzeitiger Wechsel ist häufig möglich; septische Revisionen erfordern meist zweizeitiges Vorgehen.

• Modulare Schäfte erlauben sichere Verankerung auch bei großen Defekten.

• Dual-Mobility-Systeme reduzieren Luxationsraten.

• Komplikationsrisiko hoch → sorgfältige Planung, interdisziplinäre Betreuung und präzise Technik sind entscheidend.

Schlüsselwörter

periprothetische Femurfraktur - Revisionsendoprothetik - Hüfttotalendoprothese - Bone Stock und Implantatstabilität - bone stock and implant stability - fracture management – UCS classification

Keywords

Frakturmanagement – UCS Klassifikation - periprosthetic femur fracture - revision arthroplasty - total hip replacement

Publication History

Article published online:
10 November 2025

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