Zusammenfassung
Der endoprothetische Ersatz des oberen Sprunggelenks (OSG) hat in den letzten Jahren deutliche Fortschritte verzeichnet. Mit den Prothesentypen der neueren Generation werden in der aktuellen Literatur Überlebensraten von 92–95% nach 5 Jahren berichtet. Trotzdem sind die Probleme der OSG-Arthrose schwerwiegender als diejenigen des arthrotischen Knie- oder Hüftgelenks. Zum einen sind über 80% der Arthrosen am OSG posttraumatischen Ursprungs. Deshalb ist der Weichteilmantel oft von schlechter Qualität. Häufig haben sich die Geometrie des Gelenks sowie das Alignement des Rückfußes als Ganzes verändert. Zum andern sind die Patienten im Durchschnitt ca. 10 Jahre jünger als Patienten mit Knie- oder Hüftarthrose und haben deshalb auch einen höheren Aktivitätsanspruch.
In den letzten Jahren sind zahlreiche neue OSG-Prothesen-Designs auf dem Markt erschienen. Präzisere und verlässlichere Instrumente haben die Implantationstechniken verfeinert und sicherer gemacht. Dennoch sind die Erkennung und ausreichende Behandlung der Begleitprobleme der Schlüssel für den langfristigen Erfolg in der Sprunggelenkprothetik.
Abstract
There is no doubt that total ankle replacement has much improved in recent years. Most recent reports on current ankle prosthesis designs have shown prosthesis survival rates of 92–98% after 5 years. Nevertheless, the underlying problems of osteoarthritis of the ankle are more critical than those of the hip or knee. Firstly, posttraumatic osteoarthritis in the ankle joint accounts for approximately 80% of cases. The surrounding soft tissues are often of poor quality and bony geometry and alignment may have changed significantly. Secondly, the patients are on average approximately 10 years younger than those with knee or hip osteoarthritis and therefore have a higher activity level.
Many new ankle designs have been brought onto market in recent years and new implantation techniques and instruments may have made replacement surgery easier and more reliable. However, recognition and appropriate treatment of associated problems and pathologic processes within the hind foot complex are the key issue for long-term success in total ankle replacement.
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Interessenkonflikt
Der korrespondierende Autor weist auf folgende Beziehung hin: er erhält Royalties für die Hintegra-Prothese von der Fa. Integra.
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Hintermann, B., Barg, A. Endoprothese bei Arthrose des oberen Sprunggelenks. Arthroskopie 24, 274–282 (2011). https://doi.org/10.1007/s00142-010-0611-2
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DOI: https://doi.org/10.1007/s00142-010-0611-2