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Der Orthopäde

, Volume 45, Issue 5, pp 399–406 | Cite as

Ursachen und Management der Patellainstabilitäten nach künstlichem Gelenkersatz

Lateralisation, Subluxation und Luxation
  • K.‑D. HellerEmail author
Leitthema

Zusammenfassung

Hintergrund

Patellofemorale Komplikationen nach totalendoprothetischem Ersatz des Kniegelenkes (KTEP) sind verantwortlich für eine Vielzahl von Revisionen.

Fragestellung

Die Ursachen der Instabilitäten der Patella werden differenziert aufgelistet, der Stellenwert der klinischen und bildgebenden Diagnostik wird herausgearbeitet, und Strategien zu deren Vermeidung werden dargestellt.

Material und Methode

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed und den eigenen langjährigen Erfahrungen des Autors.

Ergebnisse

Risikofaktoren für ein Maltracking sind neben dem postoperativen Genu valgum mit Malalignment des Extensormechanismus die Insuffizienz des medialen Retinaculums, die Abschwächung des Vastus medialis, die Kontraktur des Quadrizeps oder des Tractus iliotibialis, ein Restvalgus nach KTEP, Fehlrotationen von Femur und Tibia sowie die Malpositionierung der Patella, das Prothesendesign und die asymmetrische Patellaresektion. Die Ursachen im Sinne von Komponentenfehlpositionierung, fehlerhafter Patellapräparation, Beinachsenfehlstellung, Prothesendesign und Weichteilimbalance müssen erkannt werden, um das Problem gezielt zu adressieren. Die Methode der Wahl für die patellofemorale Instabilität nach Knietotalendoprothese ist üblicherweise die Operation. Vor der Operation muss der Grund der Instabilität identifiziert und korrigiert werden. Eine Operation ohne zuvor erkannten Grund ist nicht zielführend und führt nahezu regelhaft zu einem unbefriedigenden Ergebnis.

Schlussfolgerungen

Das Patella-Maltracking beim bikondylären Oberflächenersatz ist multifaktoriell und bedarf der genauesten Abklärung. Eine operative Revision empfiehlt sich nur bei eindeutig definierter Schmerzursache bzw. bei eindeutig definiertem Grund für die Fehlpositionierung der Patella.

Schlüsselwörter

Knieprothese Kniegelenk Totalendoprothese Revision Operation 

Causes and management of patellar instability after total knee replacement

Lateralization, subluxation and luxation

Abstract

Background

Patellofemoral complications after total knee arthroplasty are responsible for a variety of surgical revisions.

Objective

The causes of the various types of instability of the patella are listed in a differentiated way and the importance of clinical and imaging diagnostics as well as preventive strategies are elaborated.

Material and methods

This article is based on a selective literature search in the PubMed database and on the long-standing experience of the author.

Results

Besides postoperative genu valgum with malalignment of the extensor mechanisms, other risk factors for patellar maltracking are insufficiency of the medial retinaculum, weakening of the vastus medialis muscle, contracture of the quadriceps femoris or tractus iliotibialis muscle, residual valgus deformity after total knee replacement, femoral or tibial malrotation as well as malpositioning of the patella, inappropriate design of the prosthesis and asymmetrical resection of the patella. The causes with respect to incorrect component positioning, faulty preparation of the patella, leg malalignment, inappropriate design of the prosthesis and soft tissue imbalance have to be recognized in order to address the problem in a targeted way. The preferred method of choice in the case of patellofemoral instability after total knee replacement is normally surgery; however, the cause for the instability has to be identified and consequently corrected before surgery. Without a clearly identified cause surgical measures are unrewarding and almost regularly lead to an unsatisfactory outcome.

Conclusion

Patella maltracking after total knee arthroplasty is multifactorial and requires an accurate clarification. A surgical revision is only recommended in cases of clearly defined causes of pain or a clearly defined reason for patella malpositioning.

Keywords

Knee prosthesis Knee joint Replacement arthroplasty Surgical revision Operative procedure 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

K.-D. Heller ist als Referent für die Firmen Smith & Nephew, Aesculap, CeramTec, Brehm, Biomet und Zimmer tätig. Er erhält ein Beraterhonorar von der Fa. Aesculap, Biomet und Smith & Nephew. Er gibt an, dass im Zusammenhang mit der Erstellung des vorliegenden Beitrags kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Orthopädische Klinik BraunschweigHerzogin Elisabeth HospitalBraunschweigDeutschland

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