[Total hip arthroplasty in young patients : Bearings and custom-made prostheses]. / Hüftendoprothetik beim jungen Patienten : Gleitpaarungen und Individualendoprothesen.

BACKGROUND: Carefully and correctly implanted components are the prerequisite for the lifespan of a prosthesis. Whether higher levels of activity lead to prior failure of total hip arthroplasty in young patients is controversially discussed. The right choice of bearings is still of great relevance. BEARINGS: Ceramic-on-ceramic as well as polyethylene-on-ceramic bearings achieve comparable results, although ceramic-on-ceramic bearings should be avoided in patients with high demands on their range of motion. Polyethylene-on-metal bearings also show good clinical results, if corrosion between head and stem is absent. Metal-on-metal bearings lead to adverse systemic effects due to metal wear and should be implanted in individual cases only, e. g. as hip resurfacing. Alternative bearings have to give proof of effectivity first. Custom-made prostheses constitute an option for young patients with special conditions of hip anatomy. Planning and study results of these prostheses are elucidated in this review article.

[Joint-preserving operative treatment of avascular necrosis of the femoral head]. / Operative gelenkerhaltende Therapie der Hüftkopfnekrose.

The cause of avascular necrosis of the femoral head is multifactorial. Conservative treatment is only an option in the early stages. It is only symptomatic and not causative treatment. The implantation of an artificial hip joint should be postponed as the typically affected middle-aged males are right in the middle of their working life. Therefore, some joint-preserving operative therapies might be considered in stages ARCO I-III. Those range from core decompression to osteotomies and grafts, the advantages and disadvantages of which have to be weighted in each case. More recent therapies such as additive stem cells or platelet rich plasma (PRP) combined with core decompression have yet to prove their efficacy.

[Sense and nonsense of patient apps in arthroplasty]. / Sinn und Unsinn von Patienten-Apps in der Endoprothetik.

Apps have played a minor role in the treatment of patients in arthroplasty so far, but they represent an interesting tool for optimizing care and can become an integral part of fast-track surgery. The data in the literature is currently very limited, but promising approaches for the future are emerging. Assessing the quality of apps provided in app stores is difficult. The "DiGA listing" includes prescribable apps, which can support the patient in both the preoperative and postoperative course by optimizing lifestyle habits and providing exercise material. Patient contact with each other and with medical experts seems to have a positive impact on outcome. Most patients also rate the support provided by the app as positive. The development of the app should be done by medical experts, app developers, and patients together.

[Core decompression ("conventional method") in atraumatic osteonecrosis of the hip]. / Die "klassische" Entlastungsbohrung bei atraumatischer Hüftkopfnekrose.

OBJECTIVE: Retrograde drilling of a necrotic zone within the femoral head to reduce intraosseous pressure and stimulate revascularization. INDICATIONS: Atraumatic osteonecrosis of the hip ARCO stage I (reversible) and ARCO stage II (potentially reversible) with a medial or central necrotic zone <30% or ARCO stage III with a subchondral fracture for reduction of pain. CONTRAINDICATIONS: ARCO stage III C, ARCO stage IV (secondary osteoarthritis), stage-independent necrotic zone > 30%, infections. SURGICAL TECHNIQUE: Supine position. Visualization of the necrotic zone via an image intensifier, approach is determined by using a Kirschner wire, laterodorsal skin incision on a level with the wire, longitudinal incision of iliotibial band and vastus lateralis muscle, drilling the necrotic zone with a 2-3 mm Kirschner wire, optionally placing more wires or a hollow drill, wound closure. POSTOPERATIVE MANAGEMENT: Partial weightbearing with 20 kg for 6 weeks due to risk of fracture, followed by avoidance of jumping or sprinting for another 6 weeks; physiotherapy from day 1 after surgery, thromboembolic prophylaxis until full weightbearing is possible. RESULTS: Results are dependent on ARCO stages and are promising in early stages.