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Patientenspezifische Instrumente und Implantate beim Teilgelenkersatz des Kniegelenkes (ConforMIS iUni, iDuo)

Partial replacement of the knee joint with patient-specific instruments and implants (ConforMIS iUni, iDuo)

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Zusammenfassung

Die Knieendoprothetik ist eine erfolgreiche Standardoperation in der orthopädischen Chirurgie. Etwa 20 % der Patienten sind jedoch mit dem klinischen Ergebnis unzufrieden. Sie haben Schmerzen und erreichen nicht mehr die Aktivität wie vor der Operation. In der Literatur werden als Ursachen u. a. eine ungenaue Passform der Prothesen oder zu wenig anatomisch geformte Implantate und damit verbunden eine zu wenig physiologische Kinematik der Kniegelenke angegeben. Die Reduktion der Anzahl an unzufriedenen Patienten und die Vermeidung der damit verbundenen Revisionen sind ein wichtiges Ziel angesichts des weiter steigenden Bedarfs an künstlichen Kniegelenken. Individuell für den Patienten angefertigte Kniegelenke stellen hier eine äußerst interessante und nahe liegende Alternative zu den herkömmlichen Standardimplantaten dar. Dabei wird erstmalig die Prothese an den individuellen Knochen angepasst, wodurch die ursprüngliche Situation dieser Gelenke bestmöglich wieder hergestellt wird und dabei mehr Strukturen (Knochen, Bänder) erhalten bleiben, bzw. nur das ersetzt wird, was auch tatsächlich durch die Arthrose zerstört wurde. Sie stellen nach Autorenmeinung damit eine optimale und zukunftsweisende Ergänzung zu den bisherigen Implantaten dar. Basierend auf CT-Daten werden über eine virtuelle 3D-Rekonstruktion und dann im 3D-Druckverfahren sowohl patientenindividuelle Prothesen als auch die zur Implantation und exakten Ausrichtung notwendigen Instrumente hergestellt. Das Portfolio umfasst mediale wie laterale unikondyläre sowie mediale und laterale bikompartimentelle Prothesen (ein femorotibiales und femoropatellares Kompartiment) sowie kreuzbanderhaltende und kreuzbandsubstituierende totalendoprothetische Versorgung. Allerdings muss explizit betont werden, dass die bisherigen Literaturberichte spärlich sind und keine Langzeiterfahrungen vorliegen.

Abstract

Knee arthroplasty is a successful standard procedure in orthopedic surgery; however, approximately 20 % of patients are dissatisfied with the clinical results as they suffer pain and can no longer achieve the presurgery level of activity. According to the literature the reasons are inexact fitting of the prosthesis or too few anatomically formed implants resulting in less physiological kinematics of the knee joint. Reducing the number of dissatisfied patients and the corresponding number of revisions is an important goal considering the increasing need for artificial joints. In this context, patient-specific knee implants are an obvious alternative to conventional implants. For the first time implants are now matched to the individual bone and not vice versa to achieve the best possible individual situation and geometry and more structures (e.g. ligaments and bone) are preserved or only those structures are replaced which were actually destroyed by arthrosis. According to the authors view, this represents an optimal and pioneering addition to conventional implants. Patient-specific implants and the instruments needed for correct alignment and fitting can be manufactured by virtual 3D reconstruction and 3D printing based on computed tomography (CT) scans. The portfolio covers medial as well as lateral unicondylar implants, medial as well as lateral bicompartmental implants (femorotibial and patellofemoral compartments) and cruciate ligament-preserving as well as cruciate ligament-substituting total knee replacements; however, it must be explicitly emphasized that the literature is sparse and no long-term data are available.

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Authors and Affiliations

  1. Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland

    J. Beckmann

  2. Orthopädische Klinik König-Ludwig-Haus, Würzburg, Deutschland

    A. Steinert

  3. Orthopädische Klinik, Heinrich-Heine Universität Düsseldorf, Düsseldorf, Deutschland

    C. Zilkens

  4. Orthopädische Klinik, Universität Halle, Halle, Deutschland

    A. Zeh

  5. St. Vinzenz-Krankenhaus, Düsseldorf, Deutschland

    C. Schnurr

  6. Medical Park Chiemsee, Bernau, Deutschland

    M. Schmitt-Sody

  7. ENDO-Klinik, Hamburg, Deutschland

    M. Gebauer

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Interessenkonflikt

J. Beckmann gibt an, Beraterhonorare von ConforMIS zu erhalten. A. Steinert hat von der Firma ConforMIS Honorare für Lehrtätigkeiten erhalten. C. Zilkens, A. Zeh, C. Schnurr, M. Schmitt-Sody und M. Gebauer geben an, dass kein Interessenkonflikt besteht.

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Beckmann, J., Steinert, A., Zilkens, C. et al. Patientenspezifische Instrumente und Implantate beim Teilgelenkersatz des Kniegelenkes (ConforMIS iUni, iDuo). Orthopäde 45, 322–330 (2016). https://doi.org/10.1007/s00132-016-3237-x

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