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Kinematisches Alignment in der Knieendoprothetik

Konzept, Evidence und Limitation

Kinematic alignment in total knee arthroplasty

Concept, evidence base and limitations

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Zusammenfassung

Hintergrund

Vor dem Hintergrund weiterhin rund 20 % unzufriedener Patienten nach endoprothetischem Kniegelenkersatz ist eine neue Diskussion um das optimale Alignment in der Knieendoprothetik entfacht. Ein vielversprechender Ansatz ist dabei das kinematische Alignment (KA), das eine Prothesenpositionierung streng anhand der Drehachsen des natürlichen Knies vorsieht.

Methodik

In dieser Arbeit wird anhand eines eingehenden Literaturreviews und eigener Forschungsergebnisse das Konzept des KA, einschließlich der Limitationen und der vorhandenen klinische Evidenz erläutert.

Ergebnisse und Diskussion

Erste klinische Studien zeigen eine schnellere Patientenrehabilitation, eine verbesserte Kniefunktion und höhere Patientenzufriedenheit. Allerdings muss auf die noch dünne Evidenzlage hingewiesen werden. Die aus der Technik resultierenden Achsabweichungen zur mechanischen Achse scheinen zumindest kurzfristig keinen negativen Einfluss zu haben, Langzeitergebnisse liegen allerdings noch nicht vor. Dennoch scheint das KA nicht für jeden Patienten geeignet und weitere Untersuchungen für die Formulierung von Ein- und Ausschlusskriterien scheinen sinnvoll.

Abstract

Background

Against the background that 20 % of patients are dissatisfied after total knee arthroplasty, there is ongoing controversy about optimal alignment. In this context, orientating the prosthetic components to the natural kinematic axes of the knee appears to be an interesting new concept.

Methods

The objective of this paper is to provide a critical review of the current literature and our own research data regarding the concept of kinematically aligned total knee arthroplasty with the current evidence base and potential limitations.

Results and discussion

In the recent literature faster rehabilitation, better knee function, and higher patient satisfaction are described compared to conventional alignment, even if the postoperative alignment deviates more than 3° from the mechanical axis. However, the technique may not be suitable for every patient and pathology, and further research is necessary to set the correct indication.

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Authors and Affiliations

  1. Department Endoprothetik und Rekonstruktive Gelenkchirurgie, Orthopädische Klinik der Medizinischen Hochschule Hannover im Annastift, Anna-von-Borries-Str. 3, 30449, Hannover, Deutschland

    T. Calliess, M. Ettinger, C. Stukenborg-Colsmann & H. Windhagen

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  1. T. Calliess
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  2. M. Ettinger
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  3. C. Stukenborg-Colsmann
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  4. H. Windhagen
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Correspondence to T. Calliess.

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Interessenskonflikt

T. Calliess, M. Ettinger, C. Stukenborg-Colsmann und H. Windhagen sind Consultans für die Firma Stryker.

Dieser Beitrag enthält keine Studien an Menschen oder Tieren.

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Calliess, T., Ettinger, M., Stukenborg-Colsmann, C. et al. Kinematisches Alignment in der Knieendoprothetik. Orthopäde 44, 282–289 (2015). https://doi.org/10.1007/s00132-015-3077-0

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