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Die Knietotalendoprothese

Differenzialindikation und Ergebnisse

Total knee arthroplasty

Differential indications and results

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Beim endoprothetischen Ersatz eines arthrotisch veränderten Kniegelenks müssen Prothesendesign, Verankerungsform und Kopplungsgrad individuell festgelegt werden. Grundsätzlich wird zwischen un-, teil- und vollgekoppelten Prothesen unterschieden. Bei Stabilität der Kollateralbänder wird zumeist eine ungekoppelte Prothese gewählt. Kreuzbanderhaltendes und -substituierendes Design weisen jeweils spezifische Vor- und Nachteile auf, wobei in der Literatur keine klare Überlegenheit eines Verfahrens zu erkennen ist. Rotierende Plattformen versprechen eine Verringerung von Abrieb und Zwangskräften, erbrachten jedoch klinisch bislang keine eindeutigen Vorteile. Ist keine ausreichende Stabilität in der koronaren Ebene zu erreichen, so empfiehlt sich die Verwendung von teilgekoppelten Prothesen mit Verankerungsstielen. Bei den (teil-)gekoppelten Prothesen zeigen rotierende Plattformen signifikant bessere Ergebnisse im Hinblick auf aseptische Lockerung und Revisionsraten. Ein routinemäßiger Patellarückflächenersatz scheint bei kreuzbandsubstituierenden Designs funktionell von Vorteil zu sein. Die (teil-)zementierte Prothesenverankerung ist der zementfreien in den meisten Studien deutlich überlegen.

Abstract

For total knee arthroplasty following osteoarthritis the appropriate prosthesis design, fixation method and degree of constraint have to be decided preoperatively. In general three types of constraint are distinguished: unconstrained, semi-constrained and linked-constrained. In knees with no complex deformity or need for difficult ligament balancing an unconstrained design can be chosen. Cruciate-retaining and cruciate-substituting prostheses are both associated with certain advantages and disadvantages but according to the current literature neither technique is superior. Mobile bearings are hypothesized to reduce wear and forces applied across the knee but no clear clinical benefit has been observed. If adequate stability in the coronal plane cannot be achieved a semi-constrained prosthesis with stem fixation should be used. Among (semi-) constrained designs prostheses with a rotating platform show significantly better results with regard to aseptic loosening and revision rates. Routine resurfacing of the patella seems to be beneficial when using posterior stabilized prostheses. Most studies show superior results for cemented or hybrid fixation compared to cementless prostheses.

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Authors and Affiliations

  1. Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675, München, Deutschland

    U. Lenze, F. Pohlig, J. Schauwecker, A. Toepfer, H. Rechl, H. Gollwitzer &  R. von Eisenhart-Rothe

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  1. U. Lenze
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  2. F. Pohlig
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  3. J. Schauwecker
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  4. A. Toepfer
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  5. H. Rechl
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  6. H. Gollwitzer
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  7. R. von Eisenhart-Rothe
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Correspondence to R. von Eisenhart-Rothe.

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Lenze, U., Pohlig, F., Schauwecker, J. et al. Die Knietotalendoprothese. Arthroskopie 25, 215–222 (2012). https://doi.org/10.1007/s00142-012-0700-5

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  • DOI: https://doi.org/10.1007/s00142-012-0700-5

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