Die Hüftendoprothetik bei neuromuskulären Erkrankungen

Abstract

Primary total hip replacement in patients with neuromuscular disorders is a challenge for the surgeon and the perioperative team. Special considerations have to be given to implant selection as well as surgical approach and surgical technique. The paper presents the current literature on total hip replacements in patients with neuromuscular disorders and the authors' personal experience. Interdisciplinary perioperative management, special knowledge of the anatomic and neuromuscular pathology in patients with neuromuscular disorders, as well as detailed preoperative planning are essential to avoid complications. The choice of the surgical approach should be based on the underlying neuromuscular pathology (spastic vs. paralytic) as well as the need to extend the surgery (soft tissue balancing, femoral shortening osteotomy, acetabular reconstruction). In addition to standard implants special acetabular components might be required for patients with an increased risk of postoperative dislocation, and modular femoral components are indicated for patients with excessive femoral anteversion. Total hip replacement is a successful treatment option for patients with neuromuscular disorders. While most patients will experience pain relief, functional improvements often depend on the underlying neuromuscular disorder and the preoperative function level. The treatment is complex and requires a specialized team to optimize the outcome of the surgery.