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Knieendoprothetik bei posttraumatischer Arthrose

Knee arthroplasty in patients with posttraumatic arthritis

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Zusammenfassung

Der Gelenkersatz bei posttraumatischer Gonarthrose weist einige Besonderheiten auf. Bandinsuffizienzen, Fehlstellungen, Knochendefekte, Pseudarthrosen, Kontrakturen, problematische Weichteilverhältnisse, sowie Pathologien des Patellofemoralgelenks müssen präoperativ erkannt und bei der Operation adressiert werden. Entsprechend sind Zugang, Weichteil- und Knochenmanagement und Art der Prothese (Kopplungsgrad, Stielverankerung, Augmente) zu wählen. Einliegende Implantate und fragliche Infekte sind zu berücksichtigen und können ein zweizeitiges Vorgehen erfordern. Bei kontrakten Gelenkverhältnissen kommen erweiterte Zugänge zur Anwendung („quadriceps snip“, Tuberositasosteotomie). Im Vergleich zur Endoprothetik bei atraumatischer Gonarthrose treten funktionell schlechtere Ergebnisse auf bei geringerer Patientenzufriedenheit. Die Komplikationsrate ist bezüglich Wundheilungsstörungen, Infekten, Instabilitäten und Lockerungen erhöht, worüber die Patienten präoperativ aufzuklären sind. Der Gelenkersatz bei posttraumatischer Arthrose ist ein anspruchsvoller Eingriff. Er führt jedoch, unter Berücksichtigung der genannten Faktoren, zu einer signifikanten Beschwerdereduktion und Funktionsverbesserung.

Abstract

Arthroplasty in patients with posttraumatic arthritis can be challenging due to joint instability, malalignment, osseous defects, non-union, contracture, scarring, low-grade infections and pathologies of the patellofemoral joint. Detailed preoperative planning is recommended concerning incisions, soft tissue management, osseous reconstruction, hardware removal, potential infections and type of prosthesis (e.g. type of constraint, stems and augments). Severe difficulties can occur with exposure of the knee with respect to the extensor mechanism so that quadriceps snip or osteotomy of the tibial tuberosity may be necessary. Postoperative functional results are inferior to arthroplasty for atraumatic gonarthritis. Patients are at increased risk for intraoperative and postoperative complications (e.g. infections, instability, loosening and patellofemoral problems). Reconstructive alternatives (e.g. osteotomy, ligament reconstruction and cartilage repair) should always be considered especially in younger patients; however, most patients show a significant improvement in function and relief of pain after arthroplasty for posttraumatic gonarthritis.

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  1. Klinik für Orthopädie und Unfallchirurgie, Sana Klinikum Hameln-Pyrmont, St. Maur Platz 1, 31785, Hameln, Deutschland

    S. Hankemeier

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Hankemeier, S. Knieendoprothetik bei posttraumatischer Arthrose. Unfallchirurg 116, 427–434 (2013). https://doi.org/10.1007/s00113-013-2378-1

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  • DOI: https://doi.org/10.1007/s00113-013-2378-1

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