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Moderne 3-Komponenten-Sprunggelenkprothesen

Häufigkeit und Ursachen von Luxation und vorzeitigem Verschleiß des Polyethylengleitkerns

Modern three-piece total ankle replacement

Frequency and causes of luxation and premature wear of the polyethylene bearing

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Zusammenfassung

Bei den 3-Komponenten-Prothese der 3. Generation wird in einzelnen Arbeiten immer wieder über Komplikationen mit dem PE-Inlay wie Luxation und starkem Verschleiß berichtet. Ziel der Arbeit war es, die Ursache und Häufigkeit solcher Komplikationen anhand einer systematischen Literaturrecherche zu ermitteln und zu diskutieren.

Nach systematischer Literaturrecherche der aktuellen Literatur seit 2000 wurden 26 Originalarbeiten mit insgesamt 1318 nachuntersuchten Sprunggelenkprothesen ausgewertet. Von den in diesen 26 Arbeiten erfassten 1318 Sprunggelenkprothesen wurden insgesamt 188 (14,3%) operativ revidiert. 56 Komplikationen wurden im Zusammenhang mit dem PE-Inlay beschrieben (4,2%). In 39 Fällen (3,0%), d. h. 20,7% aller Revisionen, erfolgten Revisionen aufgrund von Komplikationen mit dem mobilen Gleitkern der untersuchten 3-Komponenten-Prothesen. Insgesamt wurden 17 Fälle mit Subluxation (1,3%), 15 Fälle wegen asymmetrischer Belastung des Inlays (1,1%), 10 Fälle wegen eines Bruches des Polyethylen- (PE-)Inlays (0,76%), 7 Prothesen wegen massivem PE-Verschleiß (0,53%) und weitere 7 Prothesen wegen Luxation des Inlays (0,53%) revidiert.

Komplikationen im Zusammenhang mit dem meniskalen Lager bei oberen Sprunggelenkprothesen wie Luxationen, Subluxationen, massivem Verschleiß und Bruch des PE-Inlays sind seltene Komplikationen, die nicht dem Funktionsprinzip der modernen 3-Komponenten-Prothesen anzulasten sind. Ursache sind meist die inkorrekte Indikationsstellung, nicht korrektes Weichteilbalancing und nicht korrekte Implantatlage, Implantation bei vorbestehendem ausgeprägtem Rückfußmalalignement oder deutlicher Sprunggelenkinstabilität.

Abstract

Luxation and excessive wear of the mobile bearing in modern three-piece total ankle replacement (TAR) is reported. We conducted a systematic review of studies to explore and discuss the rate and causes of these complications.

A systematic review of studies since 2000 showed 26 studies with altogether 1,318 followed up TARs which we analyzed. Of these 1,318 TARs, 188 (14.3%) were revised and 56 (4.2%) complications with the mobile bearing were reported. A total of 39 cases (3%), i.e., 20.7% of all revisions, were revised due to failure of the mobile bearing, including 17 cases with subluxation (1.3%), 15 with asymmetric load of the bearing (1.1%), 10 with fracture of the polyethylene (PE) inlay (0.76%), 7 with massive PE wear (0.53%), and 7 with luxation of the meniscal bearing (0.53%).

Complications due to the meniscal mobile bearing in TARs such as luxation, subluxation, massive wear, and fracture of the PE inlay are rare complications. The cause of these complications is regularly not found in the design of this three-piece total ankle replacement. Causes of failure of the mobile bearing are mostly found in incorrect indication, incorrect soft tissue balancing, incorrect positioning of components, implantation in ankles with hindfoot malalignment and ankle instability.

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  1. Abteilung Endoprothetik, Allgemeine Orthopädie und Rheumaorthopädie, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Deutschland

    A.H. Hoffmann & B. Fink

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Hoffmann, A., Fink, B. Moderne 3-Komponenten-Sprunggelenkprothesen. Orthopäde 36, 908–916 (2007). https://doi.org/10.1007/s00132-007-1141-0

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