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Revision unikondylärer Knieprothesen

Revision of unicompartmental knee arthroplasty

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Zusammenfassung

Deutlich gestiegene Implantationszahlen unikondylärer Knieprothesen bei der Gonarthrose lassen trotz insgesamt guter Überlebensraten einen zukünftigen Anstieg von Revisionseingriffen erwarten. Die Versagensgründe nach unikondylären Knieprothesen unterscheiden sich hinsichtlich Ursache und Häufigkeitsverteilung deutlich von bikondylären Prothesen. Neben einer aseptischen Lockerung stellt häufig das Fortschreiten der Arthrose im unversorgten Kompartiment eine Indikation für die Wechseloperation dar. Die Revision einer unikondylären Knieprothese wird in der Regel auf eine bikondyläre Knieprothese erfolgen.

Die präzise Feststellung des Versagensgrundes ist wesentlich für eine erfolgreiche Revision. Bei gedeckten Knochendefekten kann die Auffüllung mit Knochentransplantaten erfolgen. Bei ungedeckten Knochendefekten ist die Versorgung mit Augmentationen und Stielverlängerungen zu empfehlen. Das Revisionsimplantat sollte modular an das Ausmaß von Knochendefekten angepasst werden können.

Abstract

Despite the good midterm survivorship reported for unicondylar knee arthroplasty, an increase in revision surgery has to be expected due to increased replacement rates. The reasons for failure as well as distribution are different for unicondylar knee arthroplasty compared to total knee arthroplasty.

The main reasons for revision are aseptic loosening and the progression of osteoarthritis. In most cases, unicondylar knee arthroplasty will be revised to total knee arthroplasty. To obtain good revision results, the cause of implant failure has to be analysed carefully. In the case of contained bone defects, the reconstruction can be supported with bone grafting. For those cases with uncontained defects, implants with augmentation and, in some cases, stem extensions are needed. The modularity of the revision implant should cover different intraoperative requirements.

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie, Universitätsklinikum Carl Gustav Carus, Technische Universität, Dresden

    S. Kirschner, J. Lützner, S. Fickert & K.-P. Günther

  2. Klinik und Poliklinik für Orthopädie, Universitätsklinikum Carl Gustav Carus, Technische Universität, Fetscherstraße 74, 01307, Dresden

    S. Kirschner

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  1. S. Kirschner
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  2. J. Lützner
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  3. S. Fickert
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  4. K.-P. Günther
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Correspondence to S. Kirschner.

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Kirschner, S., Lützner, J., Fickert, S. et al. Revision unikondylärer Knieprothesen. Orthopäde 35, 184–191 (2006). https://doi.org/10.1007/s00132-005-0910-x

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