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Lösungen für häufige Komplikationen bei Teilprothetik

  • Dominic T. Mathis
  • Michael T. HirschmannEmail author
Leitthema
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Zusammenfassung

Der unikompartimentelle Kniegelenkersatz hat sich bei Patienten mit isolierter Arthrose als Alternative zur totalen Knietotalendoprothese weltweit etabliert. Ungefähr 10 % aller Arthrosefälle werden mit einer medialen Schlittenprothese, 1 % mit einer lateralen Schlittenprothese und weniger als 1 % mit einer patellofemoralen Teilprothese versorgt. Entscheidender Vorteil einer Teilprothese ist der Erhalt der Kreuz- und Seitenbänder sowie der gesunden, von der Arthrose nicht betroffenen, angrenzenden Kompartimente. Die ermöglicht den Erhalt oder die Wiederherstellung einer physiologischen Kinematik des Kniegelenks. Bei korrekter Technik kann eine annährend normale Kniefunktion („forgotten knee“) erreicht werden. Um für den einzelnen Patienten das bestmögliche Ergebnis zu erreichen, gilt es, verschiedene Schlüsselfaktoren zu berücksichtigen: enge Indikationsstellung und Patientenselektion, ausreichende Erfahrung des Operateurs, detaillierte präoperative Planung sowie eine standardisierte und ausgereifte Operationstechnik. Verbesserungen in Prothesendesign und Instrumentation, Material und chirurgischer Technik haben zusammen mit einem wachsenden Verständnis für die Wichtigkeit der optimalen Patientenselektion zu deutlich gestiegenen funktionellen Ergebnissen und Überlebensraten der Teilprothetik geführt. Die Knieteilprothese ist ein spezialisierter Eingriff, welcher in der Hand eines erfahrenen Chirurgen signifikant bessere Resultate zeigt. Sind alle Voraussetzungen erfüllt, ist die Knieteilprothetik als knochensparender und ligamenterhaltender Eingriff, unter Berücksichtigung der normalen Kniekinematik und -funktion, eine äußerst erfolgversprechende und patientenfreundliche Intervention.

Schlüsselwörter

Kniegelenk Gonarthrose Unikompartimentelle Kniegelenkersatz Komplikationen Indikationen 

Solutions for frequent complications of partial knee arthroplasty

Abstract

In patients with isolated osteoarthritis (OA) in only one part of the knee joint, unicompartmental knee arthroplasty (UKA) has become established worldwide as a suitable alternative to total knee arthroplasty (TKA). Approximately 10% of all cases of arthritis are treated with a medial prosthesis, 1% with a lateral prosthesis and <1% with a patellofemoral partial prosthesis. The most important advantage of partial knee arthroplasty is preservation of the cruciate and collateral ligaments as well as preservation of the healthy adjacent compartments, which are not affected by OA. This leads to preservation or restoration of physiological kinematics of the knee joint. With the correct technique an almost normal knee function (forgotten knee) can be achieved. In order to ensure the best possible result for the individual patient, various key factors must be taken into account: strict observation of indications and patient selection, sufficient experience of the surgeon, detailed preoperative planning as well as a standardized and sophisticated surgical technique. Improvements in prosthesis design and instrumentation, materials and surgical technique together with a growing understanding of the importance of optimal patient selection have led to significantly improved functional outcomes and survival rates of the partial prosthesis over the last 40 years. Partial knee arthroplasty is a specialized procedure, which shows significantly better results in the hands of an experienced surgeon. If all prerequisites are met, partial knee arthroplasty as a bone-sparing and ligament-preserving procedure with respect for normal knee kinematics and function, is an extremely promising and patient-friendly intervention.

Keywords

Knee joint Osteoarthritis Unicompartmental knee arthroplasty Complications Indications 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

D.T. Mathis und M.T. Hirschmann geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery and TraumatologyKantonsspital Baselland (Bruderholz, Liestal, Laufen)BruderholzSchweiz
  2. 2.University of BaselBaselSchweiz

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