Biologische Rekonstruktion lokalisiert vollschichtiger Knorpelschäden des Hüftgelenks: Empfehlungen der Arbeitsgemeinschaft „Klinische Geweberegeneration“ der DGOU und des Hüftkomitees der AGA

Abstract

Symptomatic pre-arthritic deformities such as femoroacetabular impingement (FAI) or hip dysplasia often lead to localised cartilage defects and subsequently to osteoarthritis. The present review of the working group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Trauma (DGOU) and the hip committee of the AGA (German speaking Society for Arthroscopy and Joint Surgery) provides an overview of current knowledge of the diagnosis and surgical treatment of cartilage defects, in order to infer appropriate therapy recommendations for the hip. Review of FAI and resultant cartilage damage in the hip as reported in published study findings in the literature and discussion of the advantages and disadvantages of different surgical procedures to preserve the joint. Most published studies on the surgical treatment of cartilage damage in the hip report defects caused by cam-type FAI at the acetabulum. Development of these defects can be prevented by timely elimination of the relevant deformities. At present, current full-thickness cartilage defects are mostly treated with bone marrow-stimulating techniques such as microfracture (MFx), with or without a biomaterial, and matrix-assisted autologous chondrocyte transplantation (MACT). Osteochondral autologous transplantation (OAT) is not the treatment of choice for isolated full-thickness chondral defects at the hip, because of the unfavourable risk-benefit profile. Due to the relatively short history of cartilage repair surgery on the hip, the studies available on these procedures have low levels of evidence. However, it is already becoming obvious that the experience gained with the same procedures on the knee can be applied to the hip as well. For example, limited healing and regeneration of chondral defects after MFx can also be observed at the hip joint. The cartilage surface of the acetabulum, where FAI-related chondral lesions appear, is considerably smaller than the weight-bearing cartilage surface of the knee joint. However, as in the knee joint, MACT is the therapy of choice for full-thickness cartilage defects of more than 1.5 - 2 cm. Minimally invasive types of MACT (e.g. injectable chondrocyte implants) should be preferred in the hip joint. In cases where a single-stage procedure is indicated or there are other compelling reasons for not performing a MACT, a bone marrow-stimulating technique in combination with a biomaterial covering is preferable to standard MFx. For treatment of lesions smaller than 1.5 - 2 cm the indication for a single-stage procedure is wider. As with defects in the knee, it is not possible to determine a definite upper age limit for joint-preserving surgery or MACT in the hip, as the chronological age of patients does not necessarily correlate with their biological age or the condition of their joints. Advanced osteoarthritis of the hip is a contraindication for any kind of hip-preserving surgery. Long-term observations and prospective randomised studies like those carried out for other joints are necessary.

Stellenwert der matrixaugmentierten Knochenmarkstimulation in der Behandlung von Knorpelschäden des Kniegelenks: Konsensusempfehlungen der AG Klinische Geweberegeneration der DGOU

“…Andere Gelenke: oberes Sprunggelenk und Hüftgelenk Nach dem derzeitigen Kenntnisstand geeignete Indikationen für die Anwendung der matrixaugmentierten Knochenmarkstimulation im oberen Sprunggelenk und dem Hüftgelenk, auch in Abgrenzung zu anderen Verfahren der biologischen Knorpelrekonstruktion, wurden erst kürzlich von der AG Geweberegeneration publiziert. In diesem Zusammenhang sei daher auf die beiden zugehörigen Veröffentlichungen (Papers von M. Aurich und S. Fickert et al [74,75]) mit ihren jeweils gelenkeigenen Ausführungen und Empfehlungen hingewiesen.…”

Arthroscopic matrix-associated, injectable autologous chondrocyte transplantation of the hip: significant improvement in patient-related outcome and good transplant quality in MRI assessment

“…Regarding different treatment strategies, the DGOU group "Clinical Tissue Regeneration" and the Hip Committee of the AGA have recently published current treatment recommendations [7]. Additional pathologies, such as CAM and Pincer deformities, should be concomitantly treated thoroughly and advanced osteoarthritis of the hip is a contraindication for any kind of hip-preserving surgery.…”

Biological Reconstruction of Localized Full-Thickness Cartilage Defects of the Knee: A Systematic Review of Level 1 Studies with a Minimum Follow-Up of 5 Years

“…Therefore, in addition to the extent of the joint deformity causing pre-arthritis (e.g., the extent of primary cartilage damage, axis deviation, instability, meniscus damage) and the accompanying risk factors (e.g., obesity), time is also an essential factor in the development of OA. 5,6…”

“…Therefore, in addition to the extent of the joint deformity causing pre-arthritis (e.g., the extent of primary cartilage damage, axis deviation, instability, meniscus damage) and the accompanying risk factors (e.g., obesity), time is also an essential factor in the development of OA. 5,6 The relationships described above indicate what is essential from a medical point of view. As much as possible, the therapeutic goal must be the prevention or minimization of pre-arthritis and related risk factors to prevent or at a minimum delay the development of degenerative changes.…”