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Schlittenprothese mit fixiertem Tibiainlay bei medialer Gonarthrose

Fixed bearing unicondylar arthroplasty in medial osteoarthritis of the knee

  • Operative Techniken
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Zusammenfassung

Operationsziel

Die Implantation der medialen Schlittenprothese ermöglicht den isolierten Ersatz des medialen femorotibialen Kompartiments. Damit wird nur der degenerativ veränderte Anteil des Kniegelenks endoprothetisch ersetzt, der für das klinische Beschwerdebild verantwortlich ist. Die übrigen Kompartimente des Gelenks bleiben erhalten.

Indikation

Die isolierte mediale Gonarthrose stellt eine ideale Indikation zum medialen unikondylären Gelenkersatz dar. Es sollte primär eine intraartikuläre Deformität vorliegen, d. h. eine Achsabweichung durch die femorotibiale Degeneration des Kompartiments verursacht sein.

Kontraindikation

Achsdeformitäten von >5° und Extensionsdefizite von >10° sowie eine symptomatische Arthrose in einem der übrigen Kompartimente stellen eine Kontraindikation dar.

Operationstechnik

In der vorliegenden Arbeit wird die Implantation der Schlittenprothese mit einem festen BalanSys®-Inlay beschrieben. Das Besondere der Operationstechnik besteht in der bandorientierten knöchernen Resektion am Femur. Dazu werden für die Bestimmung der Weite des Extensions- und Flexionsspalts definierte Distraktionskräfte verwendet.

Weiterbehandlung

Postoperativ ist eine sofortige Mobilisation ohne Einschränkung der Beugung unter Vollbelastung möglich. Die Patienten sollten für 4 Wochen Unterarmstützen verwenden, um muskuläre Defizite zu kompensieren. Die Antikoagulation erfolgt entsprechend der AWMF-Richtlinien (S3-Leitlinie, Stand 15. Oktober 2015) für 11–14 Tage.

Ergebnisse

Die klinischen postoperativen Ergebnisse zeigen nach 2 Jahren 87 ± 13 Punkte im Kniescore und 80 ± 10 Punkte im Funktionsscore. Die mittlere Beugefähigkeit verbesserte sich von 113°±24° vor der Operation auf 122°±23° nach der Operation. Ein präoperatives Extensionsdefizit von 10° bestand bei 9 Patienten und reduzierte sich postopertiv auf 3 Patienten.

Abstract

Objective

The unicondylar prosthesis replaces the medial femerotibial compartment only, the part presenting with osteoarthritic changes. The remaining compartments of the knee present less osteoarthritic changes and thus can be preserved.

Indications

Osteoarthritis of the medial femorotibial compartment is the ideal indication for unicondylar arthroplasty. The knee should show an intraarticular deformity, which means the malalignment is caused by the osteoarthritic changes of the medial compartment.

Contraindications

Malalignment of >5°, flexion contracture of >10°, mediolateral instability and symptomatic osteoarthritis of a second compartment should be considered as contraindications for unicondylar arthroplasty.

Surgical technique

In the current article, implantation of the BalanSys® system is presented. Femoral bony resection is solely ligament balanced. The technique allows creation of an optimal extension and flexion gap. Bone cuts were performed using a soft tissue tension device for measuring the extension and flexion gap.

Postoperative management

Full weight bearing on crutches is allowed immediately after surgery without restriction in flexion. Crutches are recommended for 4 weeks in order to compensate for neuromuscular deficits. Anticoagulation is recommended for 11–14 days according to the AWMF guidelines (S3 guidelines, Release:15 October 2015).

Results

The clinical follow-up after 2 years showed 87 ± 13 points in the knee score and 80 ± 10 points in the function score. The mean range of motion increased from 113°±24° prior to surgery to 122°±23° after surgery. A preoperative extension deficit of 10° was observed in 9 patients and reduced postoperatively in 3 patients.

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Authors and Affiliations

  1. Zentrum für Orthopädie und Unfallchirurgie, Endoprothesenzentrum Westbrandenburg, Hochschulklinikum der Medizinischen Hochschule Brandenburg Theodor Fontane, Städtisches Klinikum Brandenburg, Hochstrasse 26, 14776, Brandenburg/Havel, Deutschland

    R. Becker, C. Paech & A. Denecke

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  1. R. Becker
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  2. C. Paech
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  3. A. Denecke
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Correspondence to R. Becker.

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Interessenkonflikt

R. Becker, C. Paech und A. Denecke weisen auf folgende Beziehung hin: Royalities Fa- Medi®, Referenteneinnahmen Fa. Mathys, Forschungsgelder Mathys Foundation.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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W. Petersen, Berlin

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R. Himmelhan, Mannheim

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Becker, R., Paech, C. & Denecke, A. Schlittenprothese mit fixiertem Tibiainlay bei medialer Gonarthrose. Oper Orthop Traumatol 29, 4–16 (2017). https://doi.org/10.1007/s00064-017-0486-8

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  • DOI: https://doi.org/10.1007/s00064-017-0486-8

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