Wachstumsfaktoren und -reaktionen des gesunden und kranken kindlichen Hüftgelenks

Ohne ZusammenfassungMit 4 Textabbildungen (5 Einzelbilder)     

Radiologische Untersuchung des Hüftgelenks

Plain radiography of the hip joint is the imaging modality of first choice. The standard projections are an anteroposterior view of the whole pelvis and a lateral view of the involved hip. Depending on the suspected pathology, different lateral projections are used such as the Lauenstein view, a false profile view, or a lateral cross-table view. Additional projections may be helpful in special indications. For correct analysis and interpretation, the radiographs need to be checked for adequate orientation and exposure. The orthopedic surgeon has to be familiar with the imaging technique of each radiograph and its normal appearance in order to assess the orientation of the pelvis during exposure and to detect even subtle pathology or changes in orientation of the acetabulum or proximal femur.     

Osteochondritis dissecans des Hüftgelenks

Zussammenfassung Mit diesem Bericht sei ein Krankheitsbild im Hüftgelenke geschildert, welches zwar sicher als sehr selten gelten kann, von welchem man aber doch annehmen darf, da? es, nachdem einmal die Aufmerksamkeit darauf gelenkt ist, vielleicht jetzt doch ?fter beobachtet wird, so da? es sich den typischen Gelenkmauserkrankungen des Knie-und Ellbogengelenks an die Seite reiht.

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Mit 4 Abbildungen.     

Arthroskopische Synovektomie des Hüftgelenks

Objective

The aim of the treatment is reduction of hip pain through arthroscopic synovectomy of the hip joint, reduction in activity of the synovial disease and removal of loose bodies in chondromatosis.

Indications

Synovialitis of the hip due to synovial disease, such as pigmented villonodular synovitis (PVNS) and chondromatosis, synovialitis of the hip due to a further diseases of the hip. The disease must be treatable by arthroscopy (e.g. femoroacetabular impingement and lesion of the acetabular labrum).

Contraindications

Suspicion of malignant synovial disease, extensive synovitis, especially in those areas of the hip which are difficult to reach or inaccessible to arthroscopy, primary disease not sufficiently treatable by arthroscopy, e.g. coxarthrosis.

Surgical technique

Arthroscopy of the central compartment of the hip is carried out by lateral, anterolateral (alternatively inferior anterolateral) and posterolateral portals, using all portals both for the camera and for instruments. In the central compartment synovectomy of the acetabular fossa is performed. A shaver and/or a high frequency diathermy applicator (HF applicator) are employed for removal of the synovial membrane. For arthroscopy of the peripheral compartment lateral, anterolateral (alternatively inferior anterolateral) and superior anterolateral portals are established and all portals are used both for the camera and instruments. In the peripheral compartment, the synovial membrane of the anterior, anteromedial, anterolateral and as far as possible posterolateral areas of the hip is removed. The dorsolateral synovial plica needs to be spared.

Postoperative management

Non-steroidal anti-inflammatory drugs (NSAIDs) are administered as prophylaxis of heterotopic ossification for 10 days. Contraindications for NSAIDs need to be considered. Thrombosis prophylaxis with low molecular weight heparin over 5 days. Mobilization with full weight bearing. Intensive physiotherapeutic exercises for at least 6 and possibly up to 12 postoperative weeks. Radiosynoviorthesis 6–8 weeks after surgery depending of the histopathological results.

Results

From June 2007 to December 2013 a total of 20 patients with specific synovial diseases were treated with hip arthroscopy of which 18 had chondromatosis and 2 had PVNS. A telephone interview was carried out after an average of 40.2 months (range 8–92 months) and revealed a recurrence rate of the synovial disease of 20?%. In two cases (10?%) a second arthroscopy was necessary due to recurrent symptoms but without return of the synovial disease.     

Arthroskopische Arthrolyse des Hüftgelenks

Objective

Increase of range of motion and pain reduction for pain limited movement of the hip joint by arthroscopic arthrolysis of the peripheral compartment.

Indications

Painful primary or secondary restriction of movement of the hip joint with adhesive capsulitis and after previous surgery or additional arthroscopically treatable intra-articular changes.

Contraindications

Extensive periarticular ossification, severe arthrofibrosis and advanced arthritis of the hip.

Surgical technique

Arthroscopy of the peripheral compartment of the hip, initially using a lateral portal for the arthroscope and an anterolateral portal for instruments. After expansion of the portal entry site with a shaver and/or HF applicator and removal of scar tissue between the capsule and femoral neck, the capsule is reduced from anterolateral to anteromedial. After exchange of arthroscope and working portal, the lateral and dorsolateral arthrolysis is done.

Postoperative management

Administration of nonsteroidal anti-inflammatory drugs for prophylaxis of heterotopic ossifications. Thrombosis prophylaxis with heparin. Mobilization with full weight bearing. Intensive physiotherapeutic exercises for at least for 6 weeks and if needed for 12 postoperative weeks.

Results

After arthroscopic (n=38) or open (n=11) hip surgeries, 49 revision hip arthroscopies were performed from January 2009 to August 2013. Arthrolysis in the described technique was performed if adhesions were present. In 19 of these cases, a limitation of at least 30?% for one direction of movement was present pre-operatively. The following average values were obtained for the range of motion (preoperative/postoperative/increase): flexion 94°/128°/34 °, abduction 18°/40°/22°, internal rotation of 8°/20°/12°, external rotation 18°/38°/20°.     

Prophylaxe und Frühbehandlung der kongenitalen Dysplasie des Hüftgelenks

Ohne ZusammenfassungMit 4 Textabbildungen (12 Einzelbilder)Votrag auf der Tagung der Bayerischen Chirurgenvereinigung am 21. 7. 1962.     

Hüftarthroskopie Minimal-invasive Diagnostik und Therapie des erkrankten oder verletzten Hüftgelenks

Arthroscopy of the hip joint has developed into a useful tool for the hip surgeon. Hip joint anatomy, however, makes special demands of the arthroscopist. He needs to be familiar with the arthroscopic anatomy of the hip and its variations. Moreover, he should have practical training in the technique of hip arthroscopy prior to his first intraoperative experience in order to avoid complications. A complete arthroscopic inspection of the hip can be achieved by using a combined procedure: whereas the central hip compartment can be scoped only by distraction of the joint, the periphery can be better seen without traction. Whether to place the patient supine or lateral is dependent on personal experience. No matter which position is used, the positioning technique has to be exact. The literature has shown that most complications are related to traction. Before the first portal is placed, the joint vacuum force should be broken by distension of air or fluid. This leads to maximum distraction of the joint and reduces the risks of damage to labrum and cartilage during first access to the joint. For a diagnostic round through the central compartment, at least two portals have to be placed. The use of a 3-portal technique increases the range of inspection. Due to the relatively thin soft tissue mantle and greater distance to neurovascular structures, the anterolateral or lateral portal should be used as the first portals to the central compartment. In addition, the anterolateral portal is the standard portal to the periphery of the hip. The posterolateral or anterior portal should be used as a supplementary portal. The following indications have been described for an arthroscopic procedure of the hip: loose bodies, labral lesions, synovial diseases such as chondromatosis and pigmented villonodular synovitis, associated lesions in underlying osteoarthritis, ruptures of the teres ligament, malorientation of the acetabulum and proximal femur and, last but not least, "idiopathic" hip pain. The use of hip arthroscopy in infectious arthritis, avascular necrosis of the femoral head, Perthes' disease, osteochondrosis dissecans and complications after total hip replacement is less frequent. Here, in addition to its diagnostic value, operative arthroscopy of the hip offers removal of loose bodies, resection of the labrum and ligaments, synovial biopsy, partial synovectomy, microfracturing, lavage and placement of intraarticular drainage. The first results of arthroscopic procedures in the hip are promising. In addition to its diagnostic value and contribution to the understanding of intraarticular anatomy and pathology, recent studies have demonstrated the advantages of the arthroscopic treatment of the hip.     

Ueber freie Körper in den Gelenken

Ohne Zusammenfassung     

Komplikationen bei der Arthroskopie des Hüftgelenks und deren Therapie

Background

In recent years arthroscopic interventions of the hip joint have become increasingly more frequent. An advantage of the procedure is that open surgery can be avoided in many cases by using minimally invasive procedures. The spectrum of indications is becoming increasingly broader and more differentiated. Complications are rare.

Material and methods

According to the types of complications 13,154 cases from institutions having conducted approximately 470 hip arthroscopies per year between 2008 and 2012 were collated, observed and analysed. Intraoperative or postoperative complications were taken into account.

Results

According to our definition, the overall complication ratio came to 6.3%. Relatively frequent complications were damage caused by inadequate setup, nerve lesions and broken instruments. Severe complications such as vascular lesions, intra-or postoperative fractures, infections and avascular necrosis are rare.

Conclusion

In hip arthroscopy special attention has to be paid to patient positioning, traction performing and portal establishing. This procedure performed by an experienced surgeon resulted in a low ratio of complications.     

Arthroskopie nach Trauma des Hüftgelenks

Intra-articular injuries are common after dislocation and fracture of the hip joint and can be addressed using hip arthroscopy. The most common indications for this procedure are loose bodies, labral tears and chondral defects. In addition, preexisting femoroacetabular impingement can be addressed at the time of surgery. Arthroscopically guided fracture reduction and fixation has been described. We present two case reports of intra-articular lesions after traumatic hip dislocation. The first is a case of a man with an anterior labral tear and loose bodies after closed hip reduction. The second case is a man with a large anterior labral tear with preexisting femoroacetabular impingement. Both of them were treated by arthroscopic debridement of the unstable labrum. In addition loose bodies were removed in the first patient and a femoral osteoplasty was performed in the second patient. Hip arthroscopy has proven to be a safe and effective surgical technique for treating specific post-traumatic lesions and preexisting femoroacetabular impingement. The current case reports provide an overview of the indication for hip arthroscopy following traumatic injuries to the hip.     

Früh- und Spätergebnisse bei Alloarthroplastiken des Hüftgelenks

Ohne ZusammenfassungAus der Orthopädischen Klinik und Poliklinik der Freien Universität Berlin im Oskar-Helene-Heim (Direktor: Prof. Dr.A. N. Witt)     

Differentialdiagnose der entzündlichen Arthritis des Hüftgelenks

The differential diagnosis of inflammatory arthritis of the hip covers a broad spectrum and includes in particular crystal arthropathies and systemic rheumatic diseases. The clinical examination of joint effusion of the hip may be difficult but diagnostic ultrasound should support an early diagnosis. Radiographs remain essential in the initial diagnostic evaluation but may be of limited value in early stages of the disease. Magnet resonance imaging may be helpful in addition for the detection of early arthritis. Basic laboratory diagnostics include blood count, determination of C-reactive protein level and erythrocyte sedimentation rate. If septic arthritis is suspected blood cultures should be taken. Joint aspiration should be attempted in all cases and especially in monoarthritis. Synovial fluid analysis includes white cell count, differential count, examination for crystals and microbiological diagnostics including direct stains and cultures. The most important differential diagnoses of inflammatory arthritis of the hip joint in adults are osteoarthritis, crystal arthropathies and systemic rheumatic diseases, such as spondyloarthritis.     

Der Metall-Metall-Hybridoberflächenersatz des Hüftgelenks

Worldwide the employment of surface replacements using metal-on-metal components as an option, particularly for the young and active patient, has gained broad acceptance. Part of the attraction for hip resurfacing is its conservative nature as a prosthetic solution for hip arthritis. It is anatomical, replicating the normal hip and limb length, preserving proximal femoral bone, and is a truly minimally bone invasive approach with excellent outcome of joint function. The purpose of this article is to show the data of 1,000 Conserve(c) Plus hybrid metal-on-metal prostheses in a consecutive study of 1,140 patients with a follow-up of 5.6 years. The current Kaplan and Meier survival estimates of the prosthesis, using any conversion to total hip replacement as the end point, were 98.1% at 3 years [95% confidence interval (CI): 96.8-98.9%], 96.7% at 4 years (95% CI: 94.8-97.8%), and 95.2% at 5 years (95% CI: 93.0-96.8%). The mean postoperative Harris hip score was 93.3. The current state of metal-on-metal surface replacement is positive. The new generation of hip resurfacing has a lot of improvements. The purpose of this review of the procedure is to point out the definite improvements from earlier designs using polyethylene as well as to highlight the overall results and durability achieved by one surgeon's extensive experience and to assess the results from other series and centers. We also want to point out the areas where further investigation is needed.     

Autoplastische Operationen bei Arthrosen des Hüftgelenks

Ohne Zusammenfassung Mit 6 Textabbildungen     

Über freie Gelenkkörper

Ohne Zusammenfassung Mit 7 Textabbildungen.     

Über die tropho-statische Arthrose des Hüftgelenks

Ohne Zusammenfassung Mit 8 Textabbildungen     

Ueber Resection des Hüftgelenks bei Arthritis deformans

Ohne Zusammenfassung