Zusammenfassung
Hintergrund
Das kinematische Alignment ist eine Philosophie zur individuellen Knieprothesenimplantation in einer dreidimensionalen Betrachtung. Der Kern des Konzeptes ist das Verständnis der femoralen Flexions-Extensions-Achse als Zentrum eines Zylinders in den posterioren Kondylen. Diese Achse definiert das Knie dreidimensional über den gesamten Bewegungsablauf. Die Tibia folgt dem Femur, ist in Extension und Flexion auf das Knie balanciert, zeigt in Flexion und tiefer Flexion dann individuelle Laxitäten, häufig mit einer asymmetrisch lateral laxeren Einstellung als medial.
Auswirkungen
Als Konsequenz zeigt sich eine konstitutionelle Beinachse, die von der klassischen mechanischen Achse abweicht. Als wesentliche weitere Konsequenz wird die natürliche Gelenklinie exakt rekonstruiert. Dieses ergibt erhebliche Vorteile, da die natürliche Stabilität des Knies wiederherstellt wird und gleichzeitig eine natürliche patellare Gleitkinematik erlaubt wird. Aktuell ist nicht gänzlich geklärt, inwieweit sich Konsequenzen aus extremer Achseinstellung und Interaktion mit Gelenklinienabweichungen ergeben. Das Polyethylen als tribologisches Material und das Implantat-Knochen-Interface sind gegenüber Überlastungen vulnerabel und bedeuten möglicherweise verkürzte Standzeiten. Der menschliche Organismus verfügt jedoch offensichtlich über dynamische Mechanismen zur Reduktion des Adduktorenmomentes mit Anpassung des Gangbildes. Klinische Erfahrungen über 10 Jahre und multiple randomisierte Studien zeigen neben dem deutlichen funktionellen Vorteil der Methode keine Hinweise auf frühzeitiges Versagen und lassen die vorsichtige Verbreitung der Methode als sinnvoll erscheinen.
Abstract
Background
Kinematic alignment is a philosophy for individual knee prosthesis implantation in a three-dimensional view. The key of the concept is to understand the femoral flexion-extension axis as the centre of a cylinder within the posterior condyles. This axis defines the knee in three dimensions over the entire range of motion. The tibia follows the femur, is balanced on the knee in extension and flexion, and shows individual laxities in flexion and deep flexion.
Impacts
As a consequence, limbs will be reconstructed along their constitutional leg axis, which in most patients is different to a straight hip-knee-ankle centre axis. The method aims at perfectly reconstructing the natural joint lines, which in many patients leads to the natural oblique joint lines. This results in considerable advantages, as the natural stability of the knee is restored, and native patella kinematics are maintained. From a static view, polyethylene and the implant-bone interface may be vulnerable to mechanical overloading due to altered adductor moments. However, a growing body of evidence shows that naturally oriented knee joints show a more balanced loading pattern. Moreover, dynamic gait patterns actually show the mechanism of even reduced knee adductor moments, explaining the clinical results of up to 10 years follow up.
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Windhagen, H. Rationale des kinematischen Alignments. Orthopäde 49, 570–577 (2020). https://doi.org/10.1007/s00132-020-03937-1
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DOI: https://doi.org/10.1007/s00132-020-03937-1