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Entwicklung, Terminologie, Prinzipien und Kontroversen bei der minimal-invasiven Knieendoprothetik

Development, terminology, principles, and controversies in minimally invasive knee arthroplasty

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Zusammenfassung

Die minimal-invasive (minimal invasive surgery, MIS-)Knietotalendoprothetik ist eine logische Weiterentwicklung der positiven Erfahrungen und Ergebnisse bei der minimal-invasiven unikondylären Schlittenprothese. Die Terminologie für die minimal-invasiven Techniken bei Knietotalendoprothesen (KTEP) ist verwirrend und ein Vergleich der einzelnen MIS-Methoden damit schwierig. Eine einfache Unterteilung in weniger invasive und minimal-invasive Zugänge wird vorgestellt. Neben dem Zugang sind jedoch auch minimal-invasive chirurgische Prinzipien ganz entscheidend. Die minimal-invasive Knieendoprothetik wird derzeit noch sehr kontroversiell diskutiert. Die ersten klinischen Ergebnisse dieser neuen chirurgischen Techniken sind jedoch viel versprechend. Zurzeit besteht aber mehr „Gefühl als Wissen“. Wesentliche Fragen (Risiko-Nutzen-Analyse, welche Methode für welchen Patienten und Chirurgen, Ausbildung, Kosteneffizienz usw.) müssen von den Proponenten der minimal-invasiven Chirurgie noch beantwortet werden. Ein schrittweises Erlernen dieser neuen Techniken als „Evolution statt Revolution“ in entsprechenden Ausbildungsprogrammen ist dringend empfehlenswert. Schlussendlich müssen die Chirurgen und die Patienten entscheiden, ob diese neuen Techniken nur ein moderner Trend oder die Zukunft darstellen werden.

Abstract

Minimally invasive total knee arthroplasty is a logical and further improvement of the good results achieved with minimally invasive unicondylar knee arthroplasty. The terminology for minimally invasive surgery (MIS) is confusing and comparison of different techniques is therefore difficult. A simple separation between less invasive and minimally invasive techniques will be presented. Besides the approach, minimally invasive surgical principles are very important. MIS in total knee arthroplasty is discussed very controversially at the moment. The preliminary results of these new techniques are very promising. Up to now there is much more feeling then knowing. Important questions (risk-benefit analysis, which technique for which patient and surgeon, education and cost-effectiveness) must be addressed by the proponents of this MIS technique. Step by step learning of these new techniques (evolution instead of revolution) in specific education centres is strongly recommended. Ultimately, patients and surgeons will have to decide whether these new techniques will only be a modern trend or represent the future.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Der korrespondierende Autor hat einen Beratervertrag mit der Fa. Zimmer. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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Correspondence to Univ.-Doz. Dr. S. Hofmann.

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Hofmann, S., Pietsch, M. Entwicklung, Terminologie, Prinzipien und Kontroversen bei der minimal-invasiven Knieendoprothetik. Orthopäde 36, 1086–1092 (2007). https://doi.org/10.1007/s00132-007-1167-3

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Schlüsselwörter

  • Knieendoprothetik
  • Minimal-invasive Techniken
  • Entwicklung
  • Terminologie
  • Kontroverse

Keywords

  • Total knee arthroplasty
  • Minimally invasive surgery
  • Development
  • Terminology
  • Controversy