Primärstabilität von zementfrei implantierten Hüftprothesenschäften aus Titan mit metaphysärer Verankerung

Zusammenfassung

Studienziel: Bei Frühmobilisation unter Vollbelastung sollte die Primärstabilität von zwei verschiedenen zementfreien Titan-Hüftprothesenschäften mittels Röntgen-Stereometrie-Analyse (RSA) untersucht werden. Methode: 26 Patienten (∅ 60,8 ± 7,5 J., 16 m, 10 w, BMI 27,7 ± 3,9 kg/m²) wurden mit dem anatomisch geformten Image-Schaft (IS) (Image, Fa. Smith & Nephew, Schenefeld, Deutschland) und 20 Patienten (∅ 60,0 ± 10,9 J., 12 m, 8 w, BMI 27,5 ± 3,7 kg/m²) mit dem Bicontact-Geradschaft (BS) (Bicontact, Fa Aesculap, Tuttlingen, Deutschland) versorgt. RSA-Röntgenuntersuchungen erfolgten vor Mobilisation, 3 und 6 Wochen, 3, 6, 12 und 24 Monate postoperativ. Zusätzlich wurde der Harris-Hip-Score (HHS), der Western Ontario And McMasters Universities Osteoarthritis Index (WOMAC) sowie die Schmerzintensität mittels visueller Analogskala (VAS) erhoben. Ergebnisse: Innerhalb der ersten 3 Monate fand sich in den beiden Gruppen die stärkste Migration (Einsinken) (IS 0,647 mm, BS 0,54 mm). Ab dem 6. Monat post-OP zeigten sich nur noch Migrationen im Bereich der RSA-Messgenauigkeit. Nach 2 Jahren betrug die Migration 1,07 mm ± 0,07 mm (IS), bzw. 0,97 mm ± 0,18 mm (BS). Es konnten zu keinem Untersuchungszeitraum signifikante Unterschiede festgestellt werden. Die klinische Untersuchung zeigte eine deutliche Verbesserung des HHS, des WOMAC-Index und der VAS im Verlauf von 2 Jahren. Schlussfolgerung: Beide Prothesenschäfte zeigten eine gute Primärstabilität und eine gute Folgestabilität im untersuchten Zeitraum bei sehr guten klinischen Ergebnissen. Die Migrationswerte der beiden Schäfte lagen im Bereich publizierter RSA-Daten für zementverankerte Implantate.

Abstract

Aim: Under early mobilisation and full weightbearing the primary stability of two different cementless hip stems should be examined by using Roentgen Stereometric Analysis (RSA). Method: 26 patients (∅ 60.8 ± 7.5 J., 16 m, 10 w, BMI 27.7 ± 3.9 kg/m²) received a total hip arthroplasty with an anatomical designed image-stem (IS) (Smith & Nephew, Schenefeld, Germany), 20 patients (∅ 60.0 ± 10.9 J., 12 m, 8 w, BMI 27.5 ± 3.7 kg/m²) the Bicontact-stem (BS) (Aesculap, Tuttllingen, Germany). RSA measurements were done before mobilizing, 3 and 6 weeks, 3, 6, 12 and 24 months postoperatively. Furthermore the patients had to estimate their pain on a visually scale (VAS). We registrated the Harris-Hip-Score (HHS) and the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC). Results: Both stems showed the maximum of subsidence in the first 3 months (IS 0.647 mm, BS 0.54 mm). 6 months postoperative the measured migrations were in the range of the accuracy. After 2 years the subsidence was 1.07 mm ± 0.07 mm for the IS-group, 0.97 mm ± 0.18 mm for the BS-group. There were no significant differences in the examined parameters between the both groups. An excellent prostheses function and high activity grade with a high WOMAC score, a high HHS and a low VAS was founded for both groups. Conclusion: Both cementless implanted titanium hip stems showed a sufficient primary and midterm stability with excellent clinical results. The measured migrations do not differ from those given in literature for cemented stems.

RSA - Bicontact - Image - Primärstabilität - Migration

RSA - bicontact - image - primary stability - migration

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