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Hüftendoprothetik im Wandel der Zeit

Published on Oct 1, 2019in Journal für Mineralstoffwechsel & Muskuloskelettale Erkrankungen
· DOI :10.1007/S41970-019-00080-Y
Abstract
Bei der Koxarthrose handelt es sich um die degenerative Veranderung des Huftgelenkes, die durch einen Knorpelverschleis der Gelenkoberflachen des Femurkopfes sowie des Acetabulums charakterisiert ist. Es handelt sich hierbei um die haufigste chronische Gelenkerkrankung, die einen grosen Einfluss auf den Funktionsverlust sowie Autonomieverlust in der alteren Bevolkerung nimmt. In Schatzungen wird die Pravalenz der radiologisch sichtbaren Koxarthrose innerhalb der erwachsenen Bevolkerung mit ca. 8 % angegeben. Aufgrund der zunehmenden Alterung der Bevolkerung sowie der zunehmenden Rate an Ubergewicht ist daher auch von einer steigenden soziookonomischen Belastung fur das Gesundheitssystem auszugehen. Wahrend Huft-Totalendoprothesen traditionell uber den transglutealen Zugang nach Bauer implantiert wurden, konnten minimalinvasive anteriore Zugange durch das Hueter-Intervall etabliert werden, die sowohl zwischen Muskeln als auch zwischen Nervenversorgungsgebieten zum Huftgelenk fuhren. Im Vergleich zur ursprunglichen Operationstechnik wurden geringere postoperative Schmerzen, eine schnellere Rehabilitationsphase, eine kurze Dauer der Operation, eine kurzere Operationsnarbe, eine schnellere Ruckkehr zu taglichen Aktivitaten, eine niedrige Luxationsrate sowie ein geringerer Blutverlust postuliert. Des Weiteren wurden Fruhmobilisationsprogramme entwickelt („rapid recovery“) mit dem Ziel, durch ausfuhrliche Schulung und aktive Einbeziehung der Patienten in ihren Heilungsprozess die Verweildauer im Spital zu reduzieren und eine schnelle Ruckkehr in den beruflichen und privaten Alltag zu ermoglichen, ohne jedoch das Risiko einer fruhzeitigen stationaren Wiederaufnahme oder eines Auftretens von Fruhkomplikationen zu erhohen.
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