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Patellotrochlearer Ersatz

Indikation, Technik und Ergebnisse

Patellofemoral arthroplasty

Indication, technique and results

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Zusammenfassung

Hintergrund

Obwohl der patellotrochleare Gelenkersatz seit über 30 Jahren existiert, zählt er bis heute zu den großen Herausforderungen in der Orthopädie. Ein Grund dafür ist die komplexe Kinematik des patellofemoralen Gelenks, welches nicht nur von statischen sondern auch von dynamischen Faktoren bestimmt wird. Neue Implantatkonzepte mit koronaler und sagitaler Krümmungsauswahl und oberflächengesteuerter Inlayimplantation zeigen in Richtung der modernen patellofemoralen Endoprotethik.

Ziel

Das Ziel dieser Arbeit ist eine selektive Literaturrecherche über die Ergebnisse des patellotrochlearen Ersatzes ergänzt durch eigene aktuelle Erfahrungen.

Methode

In der dargestellten Methode werden Indikation und Technik des patellotrochlearen Ersatzes vorgestellt sowie die präoperativ relevanten diagnostischen Verfahren präsentiert. Das patellofemorale Gleitlager kann sowohl mit einem Inlay- als auch mit einem Onlayimplantat für die Trochlea rekonstruiert werden. Beide Endoprothetikkonzepte werden diskutiert. Begleitpathologien wie Instabilitäten aufgrund von Dysplasien, Achsdeformitäten, Rotationsfehlstellungen oder veränderte Weichteilstrukturen werden durch kombinierte Therapien behandelt.

Ergebnisse

Der patellotrochleare Ersatz verbessert mit einer Inlay- als auch mit einer Onlayprothese die klinischen Werte von Patienten mit symptomatischer, patellofemoraler Arthrose. Patienten mit einer instabilitätsbedingten Arthrose profitieren durchaus mehr von einem patellotrochlearen Gelenkersatz als Patienten mit primärer Arthrose, da nicht nur der Schmerz sondern auch die Begleitpathologien behoben werden.

Schlussfolgerung

Bei korrekter Indikationsstellung und Operationstechnik stellt der patellotrochleare Ersatz eine effektive Therapie zur Behandlung der patellofemoralen Arthrose dar. Ergebnisse über den Vergleich zwischen aktuellen Inlay- und Onlayprothesen sowie über deren Langzeitverlauf stehen bis dato aber noch aus.

Abstract

Background

Although patellofemoral arthroplasty has been used for more than 30 years, it is still a challenging subject in orthopedics. The reason for this are the complex kinematics of the patellofemoral joint which are influenced by dynamic and static factors. New implant concepts that incorporate multiple coronal and sagittal curvatures and surface controlled inlay implantation show a positive direction in modern patellofemoral arthroplasty.

Objectives

The purpose of this work is the review of the literature on patellofemoral arthroplasty and the presentation of our own experience.

Methods

We present indications and surgical techniques of patellofemoral arthroplasty as well as the most important aspects of preoperative evaluation. The patellofemoral joint can be reconstructed using either an inlay or an onlay prosthesis. Both arthroplasty concepts are discussed. Additional pathologies like chronic patellofemoral instabilities due to dysplasia, valgus/varus or rotational malalignment, and soft-tissue alterations are addressed with concomitant procedures.

Results

Both inlay and onlay arthroplasty have demonstrated good functional outcome scores in patients with patellofemoral osteoarthritis. Patients with patellofemoral instability and/or trochlear dysplasia may benefit more from patellofemoral arthroplasty than patients with primary osteoarthritis because not only pain but also secondary pathologies are addressed.

Conclusion

Patellofemoral arthroplasty is an effective and safe procedure if the indication criteria are respected and the specific surgical technique is used. However, comparative results on current inlay and onlay prostheses have not been published in the literature to date.

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Abbreviations

ACT:

Autologe Chondrozytentransplantation

DFO:

Distale Femurosteotomie

HTO:

Hohe tibiale Umstellungsosteotomie

ICRS:

„International Cartilage Repair Society“

MACT:

Matrixassoziierte autologe Chondrozytentransplantation

MPFL:

Mediale patellofemorales Ligament

OATS:

„Osteochondral autograft transfer system“

PFJ:

„Patello femoral joint“

TEP:

Totalendoprothese

TTTG:

Tuberositas-tibiae-Trochleagrube

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Einhaltung ethischer Richtlinien

Interessenkonflikt

A. B. Imhoff gibt an, dass er eine beratende Funktion für die Firma Arthrosurface (Franklin, MA, USA) hat. Matthias Cotic gibt an, dass kein Interessenkonflikt besteht. Die Firma Arthrosurface (Franklin, MA, USA) hat keinen Einfluss auf Design, Datenerhebung und Ergebnisinterpretation dieser Arbeit.

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Correspondence to A. B. Imhoff.

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Cotic, M., Imhoff, A. Patellotrochlearer Ersatz. Orthopäde 43, 898–904 (2014). https://doi.org/10.1007/s00132-014-3006-7

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