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Arthroskopisch gestützte Arthrodese des oberen Sprunggelenks

Operationstechnik und ihre Grenzen

Arthroscopic ankle fusion

Operative technique and its limitations

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Zusammenfassung

Hintergrund

Arthrodesen sind bewährte Eingriffe zur Behandlung der Arthrose des oberen Sprunggelenks (OSG). Das Risiko für Komplikationen, insbesondere der Weichteile, ist relevant. Unter diesem Gesichtspunkt wurde 1983 die arthroskopische Arthrodese beschrieben.

Ziel der Arbeit

Der Beitrag gibt eine Übersicht über Indikationen, Kontraindikationen und Komplikationen, Operationstechnik, Nachbehandlung und Grenzen des Vorgehens. Des Weiteren wird die Literatur diskutiert.

Diskussion

Patienten nach arthroskopischer Arthrodese des OSG zeigen eine gute Funktion, geringe Schmerzen und eine hohe subjektive Zufriedenheit. Im Vergleich zum offenen Vorgehen ist die Heilungszeit verkürzt, der Krankenhausaufenthalt kürzer und der Blutverlust geringer. Die Patienten haben weniger Schmerzen, die Rehabilitation verläuft schneller. Es treten weniger Komplikationen auf, insbesondere weniger Majorkomplikationen. Das Pseudarthroserisiko liegt wie beim offenen Vorgehen und in den meisten Studien im einstelligen Prozentbereich bei bis zu 10 %. Anschlussarthrose ist ein relevantes Problem, dessen genaue klinische Relevanz jedoch noch nicht abschließend geklärt ist. Höhergradige Fehlstellungen sind allenfalls eine relative Kontraindikation für das arthroskopische Vorgehen.

Abstract

Background

Ankle fusion is a well-accepted treatment option for end-stage ankle osteoarthritis. The risk of complications in particular concerning the soft tissue is relevant. This is why arthroscopic ankle fusion was introduced in 1983.

Objectives

We present an overview of the indications, contraindications, complications, surgical technique, follow-up treatment and limitations of the technique, and a discussion of the literature.

Discussion

Patients show a good function and little pain after arthroscopic ankle fusion and a high level of subjective patient satisfaction. In comparison to open fusion surgery the time to healing and the hospital stay is shorter and there is less blood loss. The patients have less pain and the rehabilitation is quicker. There are less complications, in particular less major complications. The risk for non-union is the same as for open fusion surgery and ranges up to 10% in most studies. Degeneration of the adjacent joints is a relevant issue. The clinical role of this adjacent joint arthritis still needs to be determined further. High-grade malalignment is a relative contraindication for arthroscopic ankle fusion.

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Author information

Correspondence to Dr. med. Matthias G. Walcher.

Ethics declarations

Interessenkonflikt

M.G. Walcher, L. Seefried, C. Konrads, P. Plumhoff, M. Hoberg, M. Rudert und L. Fraissler geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Caption Electronic Supplementary Material

Video: Zustand nach arthroskopischer OSG – Arthrodese beidseitig. Zehenspitzen- und Hakengang.

Video: Zustand nach arthroskopischer OSG – Arthrodese beidseitig. Zehenspitzen- und Hakengang.

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Walcher, M.G., Seefried, L., Konrads, C. et al. Arthroskopisch gestützte Arthrodese des oberen Sprunggelenks. Arthroskopie 31, 117–122 (2018). https://doi.org/10.1007/s00142-018-0201-2

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Schlüsselwörter

  • Arthrose
  • Weichteile
  • Endoprothetik
  • Fusion
  • Rehabilitation

Keywords

  • Arthritis
  • Soft tissue
  • Endoprosthetics
  • Fusion
  • Rehabilitation