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5 Fakten zum Gelenkersatz der Hüfte, die jede Patientin und jeder Patient kennen sollte!

Tobias 13. August 2021

Ist ein Gelenkersatz unvermeidbar?

Lediglich 14% der Patienten, bei denen ein Arzt eine Hüftgelenksarthrose diagnostiziert hat, werden tatsächlich im Laufe ihres Lebens mit einer Endoprothese versorgt.1 Durch einen richtigen Umgang mit den Schmerzen, eine Trainingstherapie und gegebenenfalls einer Gewichtsreduktion lassen sich viele Gelenkersatz-Operationen vermeiden.2,3 

Wie lange hält ein Gelenkersatz?

Im Schnitt sehr lange: Große wissenschaftliche Arbeiten zeigen, dass 3 von 4 Hüft-TEPs  15-20 Jahre und ungefähr 6 von 10 Hüft-TEPs  25 Jahre halten werden.4

Muss ich nach der Operation bestimmte Haltungen und Bewegungen vermeiden, um eine Luxation zu verhindern?

Eine Vielzahl internationaler Studien bestätigt heute, dass die Luxationsrate, unabhängig vom operativen Zugang, ohne derartige Vorsichts-maßnahmen NICHT ansteigt.5-25

Kann ich nach der Operation die neue Hüfte sofort voll belasten?

Eine sofortige Belastung des Gelenkes mit dem Körpergewicht (Vollbelastung) ist ohne eine Zunahme an Komplikationen möglich, selbst dann, wenn das Kunstgelenk ohne Knochenzement befestigt wurde.26-32

Werde ich wieder Sport treiben können? Und schadet Belastung meiner Hüfte?

Die verbesserten Prothesenmaterialien und Operations-techniken erlauben es Ihnen heute, viele Sportarten ausführen zu können.33 Auch die Haltbarkeit des Gelenkes wird durch moderaten Sport nicht negativ beeinflusst.34,35 Adäquate Bewegung und Belastung sind auch nach einer Hüft-TEP für Ihre Gesundheit und die Ihres Kunstgelenkes essentiell!36

Literaturangaben

  1. Burn, E., Murray, D. W., Hawker, G. A., Pinedo-Villanueva, R., & Prieto-Alhambra, D. (2019). Lifetime risk of knee and hip replacement following a GP diagnosis of osteoarthritis: a real-world cohort study. Osteoarthritis and Cartilage, 27(11), 1627-1635.
  2. Skou, S. T., E. M. Roos, M. B. Laursen, M. S. Rathleff, L. Arendt-Nielsen, S. Rasmussen, and O. Simonsen. “Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials.” Osteoarthritis and cartilage 26, no. 9 (2018): 1170-1180.
  3. Skou, S. T., & Roos, E. M. (2017). Good Life with osteoArthritis in Denmark (GLA: D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC musculoskeletal disorders, 18(1), 72.
  4. Evans, J. T., Evans, J. P., Walker, R. W., Blom, A. W., Whitehouse, M. R., & Sayers, A. (2019). Articles How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up
  5. van der Weegen W, Kornuijt A, Das D. Do lifestyle restrictions and precautions prevent dislocation after total hip arthroplasty? A systematic review and meta-analysis of the literature. Clin Rehabil. 2016;30(4):329-339. doi:10.1177/0269215515579421
  6. Barnsley L, Barnsley L, Page R. Are Hip Precautions Necessary Post Total Hip Arthroplasty? A Systematic Review. Geriatr Orthop Surg Rehabil. 2015;6(3):230-235. doi:10.1177/2151458515584640
  7. Allen FC, Skinner DL, Harrison J et al. The effect of precautions on early dislocations post total hip arthroplasty:a retrospective cohort study. Hip International. 2018; 28: 485.
  8. Brown ML, Ezzet KA. Relaxed hip precautions do not increase early dislocation rate following total hip  arthroplasty. American Academy of Orthopaedic Surgeons. 2019; DOI: 10.5435/JAAOS-D-19-00261.
  9. Dewal H, Maurer SL, Tsai P et al. Efficacy of abduction bracing in the management of total hip arthroplasty dislocation. Journal of Arthroplasty. 2004; 19: 733.
  10. Dietz MJ, Klein AE, Lindsey BA et al. Posterior hip precautions do not impact early recovery in total hip arthroplasty: a multicenter, randomised, controlled study. Journal of Arthroplasty. 2019; doi.org/10.1016/j.arth.2019.02.057.
  11. annucci EF, Barlow BT, Carroll KM et al. A protocol of pose avoidance in place of hip precautions after posterior-approach total hip arthroplasty may not increase risk of post-operative dislocation. HSSJ; 15: 247
  12. Gromov K, Troelsen A, Stahl Otte K et al. Removal of restrictions following primary THA with postero-lateral approach does not increase the risk of early dislocation. Acta Orthopaedica. 2015; 86: 463.
  13. Mikkelsen LR, Petersen MK, Søballe K et al. Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement? A non-randomized, controlled study. European Journal of Physical Rehabilitation in Medicine. 2014; 50: 383.
  14. Murray TG, Wetters NG, Moric M, Sporer SM, Paprosky WG, Della Valle CJ. The use of abduction bracing for the prevention of early postoperative dislocation after revision total hip arthroplasty. Journal of Arthroplasty. 2012; 27(8 Suppl): 126.
  15. Peak EL, Parvizi J, Ciminiello M et al. The role of patient restrictions in reducing the prevalence of early  dislocation following total hip arthroplasty. A randomized, prospective study. Journal of Bone and Joint  Surgery. 2005; 87: 247.
  16. Restrepo C, Mortazavi SM, Brothers J et al. Hip dislocation: are hip precautions necessary in anterior approaches? Clinical Orthopaedics and Related Research. 2011; 469: 417.
  17. Schmidt-Braekling T, Waldstein W, Akalin E et al. Minimal invasive posterior total hip arthroplasty: are 6 weeks of hip precautions really necessary. Archives of Orthopaedic Trauma Surgery. 2015; 135: 271.
  18. Van der Weegen W, Kornuijt A, Das D et al. It is safe to use minimal restrictions following posterior approachtotal hip arthroplasty: results from a large cohort study. Hip International. 2019; 29: 572.
  19. Crompton J, Osagie-Clouard L, Patel A. Do hip precautions after posterior-approach total hip arthroplasty affect dislocation rates? A systematic review of 7 studies with 6,900 patients. Acta Orthop. 2020 Dec;91(6):687-692. doi: 10.1080/17453674.2020.1795598. Epub 2020 Jul 28. PMID: 32718213; PMCID: PMC8023879.
  20. Tetreault MW, Akram F, Li J, et al. Are Postoperative Hip Precautions Necessary After Primary Total Hip Arthroplasty Using a Posterior Approach? Preliminary Results of a Prospective Randomized Trial. J Arthroplasty. 2020;35(6S):S246-S251. doi:10.1016/j.arth.2020.02.019
  21. Ververeli PA, Lebby EB, Tyler C et al. Evaluation of reducing postoperative hip precautions in total hip replacement: a randomized prospective study. Orthopedics. 2009; 32: 889.
  22. Dietz MJ, Klein AE, Lindsey BA, et al. Posterior Hip Precautions Do Not Impact Early Recovery in Total Hip Arthroplasty: A Multicenter, Randomized, Controlled Study. J Arthroplasty. 2019;34(7S):S221-S227.e1. doi:10.1016/j.arth.2019.02.057
  23. Peak EL, Parvizi J, Ciminiello M et al. The role of patient restrictions in reducing the prevalence of early dislocation following total hip arthroplasty. A randomized, prospective study. Journal of Bone and Joint Surgery. 2005; 87: 247
  24. Reimert J, Lockwood KJ, Hau R, Taylor NF. Are hip movement precautions effective in preventing prosthesis dislocation post hip arthroplasty using a posterior surgical approach? A systematic review and meta-analysis. Disabil Rehabil. 2020 Nov 15:1-7. doi: 10.1080/09638288.2020.1845404. Epub ahead of print. PMID: 33190554
  25. McNaught J, Davidson D, Ewen A, Welsh F, Maheshwari R. Patient compliance with hip precautions 12 weeks following primary elective total hip arthroplasty. Arch Orthop Trauma Surg. 2021 Mar 12. doi: 10.1007/s00402-021-03837-9. Epub ahead of print. PMID: 33709205.
  26. Wolf O, Mattsson P, Milbrink J, Larsson S, Mallmin H. The effects of different weight-bearing regimes on press-fit cup stability: a randomised study with five years of follow-up using radiostereometry. Int Orthop. 2012;36(4):735-740. doi:10.1007/s00264-011-1413-5
  27. Tian, P., Li, Z. J., Xu, G. J., Sun, X. L., & Ma, X. L. (2017). Partial versus early full weight bearing after uncemented total hip arthroplasty: a meta-analysis. Journal of orthopaedic surgery and research, 12(1), 31. https://doi.org/10.1186/s13018-017-0527-x
  28. Ström H, Nilsson O, Milbrink J, Mallmin H, Larsson S. The effect of early weight bearing on migration pattern of the uncemented CLS stem in total hip arthroplasty. J Arthroplasty. 2007;22(8):1122-1129. doi:10.1016/j.arth.2006.11.015
  29. Kishida Y, Sugano N, Sakai T, Nishii T, Haraguchi K, Ohzono K, Yoshikawa H. Full weight-bearing after cementless total hip arthroplasty. Int Orthop. 2001;25(1):25–28. doi: 10.1007/
  30. Rao RR, Sharkey PF, Hozack WJ, Eng K, Rothman RH. Immediate weightbearing after uncemented total hip arthroplasty. Clin Orthop Relat Res. 1998;349:156–162. doi: 10.1097/00003086-199804000-00019
  31. Chan YK, Chiu KY, Yip DK, Ng TP, Tang WM. Full weight bearing after non-cemented total hip replacement is compatible with satisfactory results. Int Orthop. 2003;27(2):94–97.
  32. OrthoEvidence. Full Weight Bearing Immediately After Uncemented Total Hip Arthroplasty: A Systematic Review of Randomized Trials. OE Original. 2021;4(4):1. Available from: https://myorthoevidence.com/Blog/Show/122
  33. Boettner F, Kasparek MF, Rueckl K, Liebau C. Sport nach Knie- und Hüftendoprothetik [Sport after Total Knee and Hip Arthroplasty]. Sportverletz Sportschaden. 2017;31(4):207-212. doi:10.1055/s-0043-12088
  34. Amstutz HC, Le Duff MJ. Effects of physical activity on long-term survivorship after metal-on-metal hip resurfacing arthroplasty: is it safe to return to sports?. Bone Joint J. 2019;101-B(10):1186-1191. doi:10.1302/0301-620X.101B10.BJJ-2018-1535.R2
  35. Amstutz HC, Le Duff MJ. Infographic: Effects of physical activity on long-term survivorship after metal-on-metal hip resurfacing arthroplasty. Bone Joint J. 2019;101-B(10):1184-1185. doi:10.1302/0301-620X.101B10.BJJ-2019-1091
  36. Fortier LM, Rockov ZA, Chen AF, Rajaee SS. Activity Recommendations After Total Hip and Total Knee Arthroplasty. J Bone Joint Surg Am. 2021 Mar 3;103(5):446-455. doi: 10.2106/JBJS.20.00983. PMID: 33337819
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