Skip to main content
SpringerLink
Log in

Mediale unikondyläre Schlittenprothese mit mobilem Inlay

Medial unicondylar knee arthroplasty with a mobile inlay

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Die Implantation einer medialen unikondylären Schlittenprothese mit mobilem Inlay ist bei korrekter Indikationsstellung eine zuverlässige Behandlungsoption der anteromedialen Gonarthrose mit exzellenten funktionellen Ergebnissen und sehr guten Langzeitüberlebensraten. Bei Implantaten mit mobilem Inlay stellen Alter, Gewicht, körperliches Aktivitätsniveau, Chondrokalzinose und medial betonte degenerative patellofemorale Veränderungen keine Kontraindikationen dar. Unter konsequenter Anwendung der in diesem Artikel dargestellten Indikationen und Kontraindikationen liegt der Anteil der für einen medialen unikondylären Kniegelenkersatz geeigneten Patienten mit fortgeschrittener Gonarthrose bei etwa 30 %. Durch die stetige Weiterentwicklung der Implantate und Instrumentarien ist eine reliable minimalinvasive Implantationstechnik sowohl in zementierter als auch zementfreier Verankerung etabliert. Die unikondyläre Versorgung ermöglicht im Vergleich zum bikondylären Oberflächenersatz eine schnellere Rehabilitation mit kürzerem Klinikaufenthalt und ist daher für perioperative Fast-track-Konzepte besonders geeignet. Weiterhin ermöglicht der unikondyläre Gelenkersatz mit mobilem Inlay ein hohes postoperatives Aktivitätsniveau. In Einzelstudien konnten exzellente Standzeiten der Implantate mit Überlebensraten von >90 % im Zeitraum von 10 bis 20 Jahren postoperativ aufgezeigt werden. Erhöhte Revisionsraten der unikondylären Versorgung in Registerdaten müssen im Kontext der Revisionsschwelle und der Anzahl der durchgeführten Eingriffe pro Operateur interpretiert werden. Die mediale unikondyläre Versorgung weist im Gegensatz zum bikondylären Oberflächenersatz in Registerdaten deutlich geringere Komplikationsraten für Infektionen, thrombembolische, kardiale und zerebrovaskuläre Ereignisse auf und zeigt bis 8 Jahre postoperativ eine signifikant geringere Mortalität.

Abstract

Medial unicondylar knee replacement with mobile bearings provides a reliable treatment option for anteromedial osteoarthritis with excellent functional results and very good long-term survival rates. For implants with mobile bearings patient age, weight, physical activity levels, chondrocalcinosis, and medial degenerative patellofemoral changes must not be considered as contraindications. The application of the indications and contraindications presented in this article allow for approximately 30% of patients with end-stage knee osteoarthritis to be considered as potential candidates for medial unicompatimental knee replacement. As a result of the continuous development of the implants and instruments, a reliable minimally invasive implantation technique has been established for both cemented and cementless fixation. In contrast to total knee replacement, medial unicondylar replacement allows faster rehabilitation with a shorter hospital stay and is therefore particularly suitable for perioperative “fast track” concepts. Furthermore, medial unicondylar replacement with a mobile inlay enables a high postoperative activity level. In several studies, excellent implant survival rates of >90% with a follow-up of 10–20 years were reported. Higher revision rates of unicondylar knee replacement compared to total knee replacement in registry data must be interpreted in the context of the revision threshold and the number of cases performed by the individual surgeon. In contrast to total knee replacement, medial unicondylar replacment shows significantly lower complication rates with regard to postoperative infections, thrombembolic, cardiac and cerebrovascular events and furthermore demonstrates significantly lower mortality rates up to 8 years postoperatively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Ahlback S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) 277:7–72

    Google Scholar 

  2. Aldinger PR, Clarius M, Murray DW et al (2004) Medial unicompartmental knee replacement using the “Oxford Uni” meniscal bearing knee. Orthopäde 33(11):1277–1283

    Article  CAS  PubMed  Google Scholar 

  3. Aldinger PR, Walker T, Gotterbarm T (2014) Experiences with lateral unicondylar prostheses. Orthopäde 43(10):913–922

    Article  CAS  PubMed  Google Scholar 

  4. Argenson JN, O’connor JJ (1992) Polyethylene wear in meniscal knee replacement. A one to nine-year retrieval analysis of the Oxford knee. J Bone Joint Surg Br 74(2):228–232

    CAS  PubMed  Google Scholar 

  5. Beard DJ, Pandit H, Gill HS et al (2007) The influence of the presence and severity of pre-existing patellofemoral degenerative changes on the outcome of the Oxford medial unicompartmental knee replacement. J Bone Joint Surg Br 89(12):1597–1601. https://doi.org/10.1302/0301-620X.89B12.19259

    Article  CAS  PubMed  Google Scholar 

  6. Beard DJ, Pandit H, Ostlere S et al (2007) Pre-operative clinical and radiological assessment of the patellofemoral joint in unicompartmental knee replacement and its influence on outcome. J Bone Joint Surg Br 89(12):1602–1607. https://doi.org/10.1302/0301-620X.89B12.19260

    Article  CAS  PubMed  Google Scholar 

  7. Cepni SK, Arslan A, Polat H et al (2014) Mid-term results of Oxford Phase 3 unicompartmental knee arthroplasty in obese patients. Acta Orthop Traumatol Turc 48(2):122–126. https://doi.org/10.3944/AOTT.2014.3181

    Article  PubMed  Google Scholar 

  8. Engh GA (2002) Orthopaedic crossfire – can we justify unicondylar arthroplasty as a temporizing procedure? In the affirmative. J Arthroplasty 17(4):54–55. https://doi.org/10.1054/arth.2002.32448

    Article  PubMed  Google Scholar 

  9. Fisher N, Agarwal M, Reuben SF et al (2006) Sporting and physical activity following Oxford medial unicompartmental knee arthroplasty. Knee 13(4):296–300. https://doi.org/10.1016/j.knee.2006.03.004

    Article  CAS  PubMed  Google Scholar 

  10. Gibson PH, Goodfellow JW (1986) Stress radiography in degenerative arthritis of the knee. J Bone Joint Surg Br 68(4):608–609

    CAS  PubMed  Google Scholar 

  11. Goodfellow J, O’connor J (1978) The mechanics of the knee and prosthesis design. J Bone Joint Surg Br 60-B(3):358–369

    CAS  PubMed  Google Scholar 

  12. Goodfellow J, O’connor J (1992) The anterior cruciate ligament in knee arthroplasty. A risk-factor with unconstrained meniscal prostheses. Clin Orthop Relat Res 276:245–252

    Google Scholar 

  13. Goodfellow JW, O’connor J (1986) Clinical results of the Oxford Knee. Surface arthroplasty of the tibiofemoral joint with a meniscal bearing prosthesis. Clin Orthop Relat Res 205:21–42

    Google Scholar 

  14. Goodfellow J, O’connor J, Dodd C, Murray D (2006) Design of the Oxford Knee. In: Goodfellow J, O’Connor J, Dodd C, Murray D (Hrsg) Unicompartmental arthroplasty with the Oxford Knee. Oxford University Press, Oxford, S 7–29

    Google Scholar 

  15. Goodfellow JW, Kershaw CJ, Benson MK et al (1988) The Oxford Knee for unicompartmental osteoarthritis. The first 103 cases. J Bone Joint Surg Br 70(5):692–701

    Article  CAS  PubMed  Google Scholar 

  16. Gotterbarm T (2012) Indikationen und Kontraindikationen der mobile bearing Schlittenprothese. In: Jerosch J, Franz A, Aldinger P (Hrsg) Knieteilersatz. Deutscher Ärzte-Verlag, Köln, S 146–153

    Google Scholar 

  17. Gotterbarm T (2012) Schlittenprothesen mit mobilen Polyethyleninlay. In: Jerosch J, Franz A, Aldinger P (Hrsg) Knieteilersatz. Deutscher Ärzte-Verlag, Köln, S 141–146

    Google Scholar 

  18. Gotterbarm T (2012) Historische Entwicklung der mobile-bearing Schlittenprothese. In: Jerosch J, Franz A, Aldinger P (Hrsg) Knieteilersatz. Deutscher Ärzte-Verlag, Köln, S 141–146

    Google Scholar 

  19. Halder A (2012) Indikation zur unikondylären Knieendoprothese. In: Jerosch J, Franz A, Aldinger P (Hrsg) Knieteilersatz. Deutscher Ärzte-Verlag, Köln, S 107–114

    Google Scholar 

  20. Hauptmann SM, Kreul U, Mazoochian F et al (2005) Influence of patellofemoral osteoarthritis on functional outcome after unicondylar knee arthroplasty. Orthopäde 34(11):1090–1083

    Article  Google Scholar 

  21. Hernigou P, Pascale W, Pascale V et al (2012) Does primary or secondary chondrocalcinosis influence long-term survivorship of unicompartmental arthroplasty? Clin Orthop Relat Res 470(7):1973–1979

    Article  PubMed  Google Scholar 

  22. Hooper N, Snell D, Hooper G et al (2015) The five-year radiological results of the uncemented Oxford medial compartment knee arthroplasty. Bone Joint J 97-B(10):1358–1363. https://doi.org/10.1302/0301-620X.97B10.35668

    Article  CAS  PubMed  Google Scholar 

  23. Hopper GP, Leach WJ (2008) Participation in sporting activities following knee replacement: total versus unicompartmental. Knee Surg Sports Traumatol Arthrosc 16(10):973–979

    Article  PubMed  Google Scholar 

  24. Hurst JM, Berend KR (2014) Mobile-bearing unicondylar knee arthroplasty: the Oxford experience. Clin Sports Med 33(1):105–121. https://doi.org/10.1016/j.csm.2013.06.004

    Article  PubMed  Google Scholar 

  25. Jarvenpaa J, Kettunen J, Miettinen H et al (2010) The clinical outcome of revision knee replacement after unicompartmental knee arthroplasty versus primary total knee arthroplasty: 8–17 years follow-up study of 49 patients. Int Orthop 34(5):649–653

    Article  PubMed  Google Scholar 

  26. Kang SN, Smith TO, Sprenger De Rover WB et al (2011) Pre-operative patellofemoral degenerative changes do not affect the outcome after medial Oxford unicompartmental knee replacement: a report from an independent centre. J Bone Joint Surg Br 93(4):476–478. https://doi.org/10.1302/0301-620X.93B4.25562

    Article  CAS  PubMed  Google Scholar 

  27. Kendrick BJ, Rout R, Bottomley NJ et al (2010) The implications of damage to the lateral femoral condyle on medial unicompartmental knee replacement. J Bone Joint Surg Br 92(3):374–379. https://doi.org/10.1302/0301-620X.92B3.23561

    Article  CAS  PubMed  Google Scholar 

  28. Keyes GW, Carr AJ, Miller RK et al (1992) The radiographic classification of medial gonarthrosis. Correlation with operation methods in 200 knees. Acta Orthop Scand 63(5):497–501. https://doi.org/10.3109/17453679209154722

    Article  CAS  PubMed  Google Scholar 

  29. Kozinn SC, Marx C, Scott RD (1989) Unicompartmental knee arthroplasty. A 4.5–6-year follow-up study with a metal-backed tibial component. J Arthroplasty (4 Suppl):S1–S10

  30. Kuipers BM, Kollen BJ, Bots PC et al (2010) Factors associated with reduced early survival in the Oxford phase III medial unicompartment knee replacement. Knee 17(1):48–52. https://doi.org/10.1016/j.knee.2009.07.005

    Article  PubMed  Google Scholar 

  31. Liddle AD, Pandit H, O’brien S et al (2013) Cementless fixation in Oxford unicompartmental knee replacement: a multicentre study of 1000 knees. Bone Joint J 95-B(2):181–187. https://doi.org/10.1302/0301-620X.95B2.30411

    Article  CAS  PubMed  Google Scholar 

  32. Liddle AD, Judge A, Pandit H et al (2014) Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet 384(9952):1437–1445. https://doi.org/10.1016/S0140-6736(14)60419-0

    Article  PubMed  Google Scholar 

  33. Liddle AD, Pandit H, Judge A et al (2015) Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14,076 matched patients from the National Joint Registry for England and Wales. Bone Joint J 97-B(6):793–801. https://doi.org/10.1302/0301-620X.97B6.35155

    Article  CAS  PubMed  Google Scholar 

  34. Liddle AD, Pandit H, Judge A et al (2016) Effect of surgical caseload on revision rate following total and unicompartmental knee replacement. J Bone Joint Surg Am 98(1):1–8. https://doi.org/10.2106/JBJS.N.00487

    Article  PubMed  Google Scholar 

  35. Munk S, Odgaard A, Madsen F et al (2011) Preoperative lateral subluxation of the patella is a predictor of poor early outcome of Oxford phase-III medial unicompartmental knee arthroplasty. Acta Orthop 82(5):582–588. https://doi.org/10.3109/17453674.2011.618915

    Article  PubMed  PubMed Central  Google Scholar 

  36. Murray DW, Goodfellow JW, O’connor JJ (1998) The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg Br 80(6):983–989

    Article  CAS  PubMed  Google Scholar 

  37. Murray DW, Pandit H, Weston-Simons JS et al (2013) Does body mass index affect the outcome of unicompartmental knee replacement? Knee 20(6):461–465. https://doi.org/10.1016/j.knee.2012.09.017

    Article  CAS  PubMed  Google Scholar 

  38. Pandit H, Jenkins C, Barker K et al (2006) The Oxford medial unicompartmental knee replacement using a minimally-invasive approach. J Bone Joint Surg Br 88(1):54–60. https://doi.org/10.1302/0301-620X.88B1.17114

    Article  CAS  PubMed  Google Scholar 

  39. Pandit H, Jenkins C, Gill HS et al (2011) Unnecessary contraindications for mobile-bearing unicompartmental knee replacement. J Bone Joint Surg Br 93(5):622–628. https://doi.org/10.1302/0301-620X.93B5.26214

    Article  CAS  PubMed  Google Scholar 

  40. Pandit H, Hamilton TW, Jenkins C et al (2015) The clinical outcome of minimally invasive Phase 3 Oxford unicompartmental knee arthroplasty: a 15-year follow-up of 1000 UKAs. Bone Joint J 97-B(11):1493–1500. https://doi.org/10.1302/0301-620X.97B11.35634

    Article  CAS  PubMed  Google Scholar 

  41. Pandit HG, Campi S, Hamilton TW et al (2017) Five-year experience of cementless Oxford unicompartmental knee replacement. Knee Surg Sports Traumatol Arthrosc 25(3):694–702

    Article  CAS  PubMed  Google Scholar 

  42. Panzram B, Bertlich I, Reiner T et al (2017) Cementless Oxford medial unicompartimental knee replacement: an independent series with a 5-year-follow-up. Arch Orthop Trauma Surg 137(7):1011–1017

    Article  PubMed  Google Scholar 

  43. Panzram B, Bertlich I, Reiner T et al (2017) Results after cementless medial Oxford unicompartmental knee replacement – incidence of radiolucent lines. PLOS ONE 12(1):e170324. https://doi.org/10.1371/journal.pone.0170324

    Article  PubMed  PubMed Central  Google Scholar 

  44. Pietschmann MF, Wohlleb L, Weber P et al (2013) Sports activities after medial unicompartmental knee arthroplasty Oxford III-what can we expect? Int Orthop 37(1):31–37

    Article  PubMed  Google Scholar 

  45. Price AJ, Svard U (2011) A second decade lifetable survival analysis of the Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res 469(1):174–179

    Article  PubMed  Google Scholar 

  46. Price AJ, Dodd CA, Svard UG et al (2005) Oxford medial unicompartmental knee arthroplasty in patients younger and older than 60 years of age. J Bone Joint Surg Br 87(11):1488–1492. https://doi.org/10.1302/0301-620X.87B11.16324

    Article  CAS  PubMed  Google Scholar 

  47. Price AJ, Waite JC, Svard U (2005) Long-term clinical results of the medial Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res 435:171–180

    Article  Google Scholar 

  48. Saragaglia D, Estour G, Nemer C et al (2009) Revision of 33 unicompartmental knee prostheses using total knee arthroplasty: strategy and results. Int Orthop 33(4):969–974

    Article  PubMed  Google Scholar 

  49. Saxler G, Temmen D, Bontemps G (2004) AMC unicondylar prosthesis. Orthopäde 33(11):1267–1276

    Article  CAS  PubMed  Google Scholar 

  50. Saxler G, Temmen D, Bontemps G (2004) Medium-term results of the AMC-unicompartmental knee arthroplasty. Knee 11(5):349–355. https://doi.org/10.1016/j.knee.2004.03.008

    Article  PubMed  Google Scholar 

  51. Schlueter-Brust K, Kugland K, Stein G et al (2014) Ten year survivorship after cemented and uncemented medial uniglide unicompartmental knee arthroplasties. Knee 21(5):964–970. https://doi.org/10.1016/j.knee.2014.03.009

    Article  PubMed  Google Scholar 

  52. Seeger JB, Haas D, Jager S et al (2012) Extended sagittal saw cut significantly reduces fracture load in cementless unicompartmental knee arthroplasty compared to cemented tibia plateaus: an experimental cadaver study. Knee Surg Sports Traumatol Arthrosc 20(6):1087–1091

    Article  CAS  PubMed  Google Scholar 

  53. Svard UC, Price AJ (2001) Oxford medial unicompartmental knee arthroplasty. A survival analysis of an independent series. J Bone Joint Surg Br 83(2):191–194. https://doi.org/10.1302/0301-620X.83B2.10966

    Article  CAS  PubMed  Google Scholar 

  54. Walker T, Gotterbarm T, Bruckner T et al (2014) Total versus unicompartmental knee replacement for isolated lateral osteoarthritis: a matched-pairs study. Int Orthop 38(11):2259–2264. https://doi.org/10.1007/s00264-014-2473-0

    Article  PubMed  Google Scholar 

  55. Walker T, Streit J, Gotterbarm T et al (2015) Sports, physical activity and patient-reported outcomes after medial unicompartmental knee arthroplasty in young patients. J Arthroplasty 30(11):1911–1916. https://doi.org/10.1016/j.arth.2015.05.031

    Article  PubMed  Google Scholar 

  56. Walker T, Streit MR, Gotterbarm T et al (2015) Tips and tricks for mobile bearing medial unicondylar knee replacement. Z Orthop Unfall 153(3):331–333. https://doi.org/10.1055/s-0035-1546011

    Article  CAS  PubMed  Google Scholar 

  57. Walker T, Streit MR, Streit J et al (2015) Indications and borderline indications for medial mobile bearing unicondylar knee replacement. Z Orthop Unfall 153(05):516–525. https://doi.org/10.1055/s-0035-1546237

    Article  CAS  PubMed  Google Scholar 

  58. Weale AE, Murray DW, Crawford R et al (1999) Does arthritis progress in the retained compartments after ‘Oxford’ medial unicompartmental arthroplasty? A clinical and radiological study with a minimum ten-year follow-up. J Bone Joint Surg Br 81(5):783–789

    Article  CAS  PubMed  Google Scholar 

  59. White SH, Ludkowski PF, Goodfellow JW (1991) Anteromedial osteoarthritis of the knee. J Bone Joint Surg Br 73(4):582–586

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland

    C. Merle M.Sc.,  T. Walker &  T. Gotterbarm

  2. Orthopädische Klinik Paulinenhilfe, Diakonieklinikum Stuttgart, Rosenbergstr. 38, 70176, Stuttgart, Deutschland

    P. R. Aldinger

Authors
  1. C. Merle M.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Walker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. R. Aldinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Gotterbarm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Gotterbarm.

Ethics declarations

Interessenkonflikt

C. Merle führt Operationskurse und Vorträge zu Knieprodukten der Firma Zimmer Biomet durch. T. Walker gibt an, dass kein Interessenkonflikt besteht. P.R. Aldinger und T. Gotterbarm sind als Berater für Knieprodukte der Firma Zimmer Biomet tätig. Sie führen Hospitation und Vorträge zu deren Produkten durch.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Teile des vorliegenden Artikels wurden bereits veröffentlicht [16,17,18, 56, 57].

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Merle, C., Walker, T., Aldinger, P.R. et al. Mediale unikondyläre Schlittenprothese mit mobilem Inlay. Arthroskopie 30, 293–301 (2017). https://doi.org/10.1007/s00142-017-0166-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00142-017-0166-6

Schlüsselwörter

Keywords

Search

Navigation