Risiko Hüftluxation – welche Patienten brauchen besondere Maßnahmen?

Zusammenfassung

Einleitung: Die Luxation einer Hüfttotalendoprothese (Hüft-TEP) stellt eine der Hauptkomplikationen nach Primärimplantation und Revisionsintervention dar. Die Definition von operations-, indikations- und patientenspezifischen Risikofaktoren ermöglicht, risikobehaftete Patienten zu erkennen. Ziel: Ziel dieser Arbeit ist es, bekannte patientenspezifische Risikofaktoren, wie Body-Mass-Index (BMI), Alter und Geschlecht, für eine Primärluxation in Bezug auf eine Sekundärluxation zu evaluieren. Hierbei soll der Frage nachgegangen werden, ob ein erhöhter BMI, fortgeschrittenes Alter und weibliches Geschlecht eine Zweitluxation begünstigen. Methode: Zur Identifikation von Risikofaktoren für ein Luxationsereignis nach Hüft-TEP erfolgte die retrospektive Auswertung aller Erst- bzw. Rezidivluxationen, welche zwischen 2007 und 2011 in unserer Klinik behandelt wurden. 106 Patienten ohne Indikation zur Wechseloperation nach erfolgter Primärluxation wurden eingeschlossen und primär konservativ behandelt. Die Kohorte wurde in Abhängigkeit des Therapieerfolgs in 2 Gruppen unterteilt und die patientenspezifischen Risikofaktoren (BMI, Alter, Geschlecht) analysiert. Gruppe I (n = 32) beinhaltet die Patienten ohne Reluxationsereignis nach der primären Luxation, während in Gruppe II (n = 74) Patienten mit Reluxationsereignis eingeschlossen wurden. Ergebnisse: Das durchschnittliche Alter zum Zeitpunkt der Erstluxation betrug 68 ± 14 Jahre (32 % Männer und 68 % Frauen). Eine Reluxation trat in 74 (70 %) Fällen auf. Bei der Betrachtung des BMI wies die Gruppe II einen signifikant höheren BMI (27,11 ± 6,24 kg/m²) auf im Vergleich zur Gruppe I (24,49 ± 4,86 kg/m²; p = 0,02). Ein signifikanter Einfluss des Alters konnte nicht nachgewiesen werden (p = 0,70). In der Gruppe I wurde ein durchschnittliches Alter von 71 ± 16 Jahren und in der Gruppe II von 70 ± 13 Jahren errechnet. Dagegen fand sich ein 2,33-fach höheres Vorkommen einer Primär- und Rezidivluxation bei Frauen gegenüber Männern. Ein höheres Risiko für eine Rezidivluxation bei Frauen fand sich jedoch nicht (p = 0,43). Zusammenfassung: Ein erhöhter Body-Mass-Index geht mit einer signifikanten Erhöhung des Risikos einer Rezidivluxation einher. Alter und Geschlecht beeinflussen das Risiko für eine Zweitluxation jedoch nicht. Die Hüftgelenksluxation ist jedoch ein multifaktorielles Ereignis, das neben patientenspezifischen Faktoren auch durch indikations- und operationsspezifische Parameter bestimmt wird.

Abstract

Introduction: Dislocation of a hip arthroplasty is one of the main complications after primary or revision surgery. Definition of specific risk factors concerning patient, indication and surgery makes it possible to determine risk patients for dislocation. Aim: The aim of this study is to identify patient-specific risk factors, such as body mass index (BMI), age and gender, in order to evaluate primary dislocation and to correlate with secondary dislocation. It is investigated whether high BMI, advanced age or female gender are able to promote secondary dislocation. Method: In order to identify risk factors for dislocation after primary and revision hip arthroplasty, a retrospective analysis for dislocation was performed of all hip arthroplasties treated in our hospital between 2007 and 2011. 106 patients without an indication for surgical revision were included and treated conservatively. The patient cohort was divided into two groups, depending on the success of the therapy and were analysed for BMI, age and gender. Group I (n = 32) included patients without a re-dislocation event, in contrast to group II (n = 74), which included patients with re-dislocation of the hip arthroplasty. Results: The mean age at the time of primary dislocation was 68 ± 14 years (32 % male and 68 % female). Re-dislocation was presented in 74 cases (70 %). Group II showed a significantly higher BMI (27.11 ± 6.24 kg/m²) than group I (24.49 ± 4.86 kg/m²; p = 0.02). There was no significant effect of age (p = 0.70). The mean age in group I was 71 ± 16 years and in group II of 70 ± 13 years. The incidence of hip dislocation was 2.33-fold higher in women than in men. There was no significant difference between the genders with respect to the risk of re-dislocation. Summary: A higher BMI correlates significantly with a greater risk of re-dislocation of a hip arthroplasty. On the other hand, age and gender do not influence the risk. However, the dislocation of a hip arthroplasty is a multifactorial event, which can be influenced by patient-specific factors as well as specific factors for indication and operation technique.

Schlüsselwörter

Hüft-TEP-Luxation - Risikofaktoren - Hüftendoprothese

Key words

revision hip dislocation - risk factors - hip arthroplasty - revision

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