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Periprothetische Frakturen des Kniegelenkes

Periprosthetic knee fractures

  • Leitthema
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Zusammenfassung

Hintergrund

Die kumulative Inzidenz periprothetischer Frakturen am Kniegelenk nimmt weiterhin zu. Ursache dafür ist zunächst die steigende Zahl knieendoprothetischer Operationen; aber auch die zunehmende Zahl von Wechseleingriffen, die höhere Lebenserwartung und Komorbiditäten spielen eine wichtige Rolle.

Ziel der Arbeit

Lokale Faktoren wie Fehlstellungen, knöcherne Defekte, benachbarte Implantate, aseptische Lockerungen, low-grade Infekte sind von Relevanz und können eigentliche Ursache einer scheinbar traumatisch induzierten Fraktur sein. Eine differenzierte Diagnostik vor der Behandlung der periprothetischen Fraktur ist weichenstellend, wobei der damit befasste Arzt Erfahrungen sowohl in der Frakturbehandlung als auch in der Wechselendoprothetik haben muss. Die vorliegende Arbeit soll einen Überblick darüber geben.

Ergebnisse

Es liegen valide Klassifikationen der periprothetischen Frakturen nach Knietotalendoprothese (Knie-TEP) für die drei Lokalisationen an Femur, Tibia und Patella vor, die die grundsätzliche Ausrichtung der Therapie vorgeben.

Schlussfolgerungen

Gerade in Kenntnis des heutigen breiten Therapieportfolios, der generell hohen Komplikationsraten und der oftmals heterogenen funktionellen Resultate wird deutlich, dass nur eine korrekte Analyse des Schadensbildes und die Umsetzung in ein individuell adaptiertes Behandlungskonzept die Grundlage dafür bietet, die periprothetische Fraktur derart zu therapieren, dass dem Patienten eine akzeptable Wiederherstellung der Funktion bei frühzeitiger Belastungsstabilität und möglichst langer Standzeit der Rekonstruktion geboten wird. Dem Komplikationsmanagement kommt dabei eine entscheidende Rolle zu.

Abstract

Background

The cumulative incidence of periprosthetic fractures around the knee is increasing further because of an extended indication for knee replacement, previous revision arthroplasty, rising life expectancy and comorbidities.

Aim of the work

The relevance of local parameters such as malalignment, osseous defects, neighbouring implants, aseptic loosening and low-grade infections may sometimes be hidden behind the manifestation of a traumatic fracture. A differentiated diagnostic approach before the treatment of a periprosthetic fracture is of paramount importance, while the physician in-charge should also have particular expertise in fracture treatment and in advanced techniques of revision endoprosthetics. The following work gives an overview of this topic.

Results

Valid classifications are available for categorising periprosthetic fractures of the femur, the tibia and the patella respectively, which are helpful for the selection of treatment.

Conclusions

With the wide-ranging modern treatment portfolio bearing in mind the substantial rate of complications and the heterogeneous functional outcome, the adequate analysis of fracture aetiology and the corresponding transformation into an individualised treatment concept offer the chance of an acceptable functional restoration of the patient at early full weight-bearing and prolonged implant survival. The management of complications is crucial to the final outcome.

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Literatur

  1. http://www.SQG.de. Zugegriffen: 29. Aug. 2015

  2. Ayers DC (1997) Supracondylar fracture of the distal femur proximal to a total knee replacement. Instr Course Lect 46:197–203

    PubMed  CAS  Google Scholar 

  3. Browne JA, Hanssen AD (2011) Reconstruction of patellar tendon disruption after total knee arthroplasty. J Bone Joint Surg 93-A:1137–1143

    Google Scholar 

  4. Burnett RS, Bourne RB (2004) Periprosthetic fractures of the tibia and patella in total knee arthroplasty. Instr Course Lect 53:217–235

    PubMed  Google Scholar 

  5. Citak C, Klatte TO, Kendoff D, Haaspers C, Gehrke T, Gebauer M (2013) Treatment of interprosthetic fractures with an interposition prosthesis. Acta Orthop 84:326–327

    Article  PubMed  PubMed Central  Google Scholar 

  6. Della Rocca G, Leung KS, Pape H-C (2011) Periprosthetic fractures: epidemiology and future projections. J Orthop Trauma 25:S66–S70

    Article  PubMed  Google Scholar 

  7. Della Rocca G (2013) Periprosthetic fractures around the knee – an overview. J Knee Surg 26:3–8

    Article  PubMed  Google Scholar 

  8. Duncan CP, Haddad FS (2014) The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Joint J 96-B:713–716

    Article  PubMed  CAS  Google Scholar 

  9. Ebraheim NA, Sochacki KR, Liu X, Hirschfield G, Liu J (2013) Locking plate fixation of periprosthetic femur fractures with and without cerclage wires. Orthop Surg 5:183–187

    Article  PubMed  Google Scholar 

  10. Ehlinger M, Scheibling B, Rahme M, Brinkert D, Schenck B, Di Marco A, Adam P, Bonnomet F (2015) Minimally invasive surgery with locking plate for periprosthetic femoral fractures: technical note. Int Orthop 39(10):1921–1926 (epub ahead of print)

    Article  PubMed  Google Scholar 

  11. Ehlinger M, Adam P, Abane L, Rahme M, Moor BK, Arlettaz Y (2011) Treatment of periprosthetic femoral fractures of the knee. Knee Surg Sports Traumatol Arthrosc 19:1473–1489

    Article  PubMed  Google Scholar 

  12. Ehlinger M, Adam P, Arlettaz Y, Moor BK, DiMarco A, Brinkert D, Bonnomet D (2011) Minimally-invasive fixation of distal femoral extra-articular femur fractures with locking plates: limitations and failures. Orthop Traumatol Surg Res 97:674–680

    Google Scholar 

  13. Erhardt JB, Kuster MS (2010) Periprothetische Frakturen am Kniegelenk. Orthopäde 39:97–108

    Article  PubMed  CAS  Google Scholar 

  14. Felix NA, Stuart MJ, Hanssen AD (1997) Periprosthetic fractures of the tibia associated with total knee arthroplasty. Clin Orthop 345:113–124

    PubMed  Google Scholar 

  15. Goldberg VM, Figgie HE III, Inglis AE, Figgie MP, Sobel M, Kelly M, Kraay M (1988) Patella fracture type and prognosis in condylar total knee arthroplasty. Clin Orthop 236:115–122

    PubMed  Google Scholar 

  16. Hoffman MF, Jones CB, Sietsema DL, Koenig SJ, Tornetta P (2012) Outcome of periprosthetic distal femur fractures following total knee arthroplasty. Injury 43:1084–1089

    Article  Google Scholar 

  17. Jassim SS, Mcnamara I, Hopgood P (2013) Distal femoral replacemen in periprosthetic fracture around total knee arthroplasty. Injury 45:550–553

    Article  PubMed  Google Scholar 

  18. Kim, K-I, Egol KA, Hozack WJ, Parvizi J (2006) Periprosthetic fractures after total knee arthroplasties. Clin Orthop Rel Res 446:167–175

    Article  Google Scholar 

  19. Lewis PL, Rorabeck CH (1997) Periprosthetic fractures. In: Engh CA, Rorabeck CH (Hrsg) Revision total knee arthroplasty. Williams & Wilkins, Baltimore, S 275–295

    Google Scholar 

  20. Meek RMD, Norwood T, Smith R, Brenkel U, Howie CR (2011) The risk of periprosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Br 93:96–101

    Article  PubMed  CAS  Google Scholar 

  21. Meyer C, Alt V, Schroeder L, Heiss C, Schnettler R (2007) Treatment of periprothetic femoral fractures by effective lengthening of the protthesis. Clin Orthop Rel Res 463:120–127

    Google Scholar 

  22. Mittlmeier T, Stöckle U, Perka C, Schaser K-D (2005) Periprothetische Frakturen nach Knietotalendoprothetik. Unfallchirurg 108:481–496

    Article  PubMed  CAS  Google Scholar 

  23. Mortazavi SMJ, Kurd MF, Bender B, Pos Z, Parvizi J, Purtill JJ (2010) Distal femoral arthroplasty for the treatment of periprosthetic fractures after total knee arthroplasty. J Arthroplasty 25:775–780

    Article  PubMed  Google Scholar 

  24. Nauth A, Ristevski B, Bégué T, Schemitsch EH (2011) Periprosthetic distal femur fracture: current concepts. J Orthop Trauma 25:S82–S85

    Article  PubMed  Google Scholar 

  25. Ortiguera CJ, Berry DJ (2004) Patellar fracture after total knee arthroplasty. J Bone Joint Surg 84-A:532–540

    Google Scholar 

  26. Parvizi J, Jain N, Schmidt AH (2008) Periprosthetic knee fractures. J Orthop Trauma 22:663–671

    Article  PubMed  Google Scholar 

  27. Parvizi J, Gehrke T, Chen AF (2013) Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J 95:1450–1452

    Article  PubMed  Google Scholar 

  28. Ristevski B, Nauth A, Williams D, Hall J, Whelan D, Bhandari M, Schemitsch EH (2014) Systematic review of the treatment of periprosthetic distal femur fractures. J Orthop Trauma 28:307–312

    Article  PubMed  Google Scholar 

  29. Rorabeck CH, Taylor JW (1999) Classification of periprosthetic fracture complicating total knee arthroplasty. Orthop Clin North Am 30:209–214

    Article  PubMed  CAS  Google Scholar 

  30. Ruchholtz S, Tomás J, Gebhard F, Larsen MS (2013) Periprosthetic fractures around the knee – the best way of treatment. Eur Orthop Traumatol 4:93–102

    Article  PubMed  PubMed Central  Google Scholar 

  31. Saidi K, Ben-Lulu O, Tsuji M, Safir O, Gross AE, Backstein D (2014) Supracondylar periprosthetic fractures of the knee in the elderly patients: a comparison of treatment using allograft-implant composites, standard revision components, distal femoral replacement prosthesis. J Arthroplasty 29:110–114

    Article  PubMed  Google Scholar 

  32. Singh JA, Jensen M, Lewallen D (2013) Predictors of periprosthetic fracture after total knee replacement. Acta Orthop 84:170–177

    Article  PubMed  PubMed Central  Google Scholar 

  33. Su ET, DeWal H, Di Cesare PE (2004) Periprosthetic femoral fractures above knee replacements. J Am Acad Orthop Surg 12:12–20

    PubMed  Google Scholar 

  34. Van der Merwe JM, Haddad FS, Duncan CP (2014) Field testing of the Unified Classification System for peiprothetic fracturesd of the femur, tibia and patella in association with knee replacement: an international collaboration. Bone Joint J 96-B:1669–1673

    Article  PubMed  Google Scholar 

  35. Whitehouse MR, Mehendale S (2014) Periprosthetic fractures around the knee: current concepts and advances in management. Curr Rev Muskuloskelet Med 7(2):136–144

    Article  Google Scholar 

  36. Yoo JD, Kim NK (2015) Periprosthetic fractures following total knee arthroplasty. Knee Surg Rel Res 27:1–9

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie, Chirurgische Klinik und Poliklinik, Universitätsmedizin Rostock, Schillingallee 35, 18055, Rostock, Deutschland

    T. Mittlmeier &  A. Wichelhaus

  2. Klinik für Orthopädie und Unfallchirurgie, St. Bernward Krankenhaus, Treibestraße 9, 31134, Hildesheim, Deutschland

    M. Beck

  3. International Neuroscience Institute, INI Hannover GmbH, Rudolf-Pichlmayr-Str. 4, 30625, Hannover, Deutschland

    U. Bosch

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  1. T. Mittlmeier
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  4. A. Wichelhaus
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Correspondence to T. Mittlmeier.

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Mittlmeier, T., Beck, M., Bosch, U. et al. Periprothetische Frakturen des Kniegelenkes. Orthopäde 45, 54–64 (2016). https://doi.org/10.1007/s00132-015-3205-x

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