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Erfahrungen mit medialen monokondylären Prothesen mit mobilem Plateau

Experience with medial unicompartmental prostheses with a mobile plateau

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Zusammenfassung

Hintergrund

Der unikondyläre Oberflächenersatz (UKA) ist ein fester Bestandteil in der Therapie der medialen Gonarthrose. Die schnelle Rehabilitation, gute Beweglichkeit und die zunehmend besseren Standzeiten haben insbesondere bei jüngeren Patienten mit einem hohen funktionellen Anspruch zu einer Zunahme der Operationszahlen geführt.

Fragestellung

Ziel unserer Untersuchung war die Evaluation des sportlichen Aktivitätsgrades nach Implantation einer UKA sowie des Einflusses der Prothesenposition und des rertropatellaren Arthrosegrades auf das klinische Outcome.

Material und Methoden

Von 181 Kniegelenken, die eine Oxford-Phase-III-UKA mit mobilem Inlay implantiert bekamen, konnten 136 nachuntersucht werden (75,1 %). Das Durchschnittsalter bei Prothesenimplantation lag bei 65,2 Jahren, das mittlere Follow-up betrug 4,2 Jahre. Neben einer klinischen und radiologischen Untersuchung wurden der WOMAC-, OKS-, der KSS-, der UCLA-Activity- sowie der Turba-Score erhoben.

Ergebnisse

Ihre sportliche Betätigung nach Implantation der Oxford-III-Prothese führten 81 % der Patienten fort. Es konnte kein erhöhtes Risiko zwischen sportlicher Aktivität und Revisionsrate, Inlayluxation oder Arthroseprogression festgestellt werden. Die sportlich aktive Gruppe wies in allen klinischen Scores bessere Ergebnisse auf als die inaktive Gruppe. Die korrekte Implantatpositionierung, insbesondere das Vermeiden einer Überkorrektur in einen Valgus sind wichtige Faktoren für ein gutes klinisches Ergebnis.

Diskussion

Die Ergebnisse belegen, dass nach Implantation einer UKA vom Typ Oxford III eine sportliche Betätigung sehr gut möglich ist und die Patienten eine deutliche subjektiven Verbesserung ihres Gesundheitszustands erlangen, ohne dabei ein erhöhtes Risiko für Komplikationen einzugehen.

Abstract

Background

Unicompartmental knee arthroplasty (UKA) has become an accepted therapy for medial osteoarthritis. The main reasons for its popularity are the minimally invasive surgical technique and the reports of excellent long-term results including high patient satisfaction and good knee joint function especially in younger patients.

Objectives

The purpose of our retrospective study was to evaluate the physical activities of patients who had undergone an Oxford III medial UKA. Special attention was paid to implant positioning and osteoarthritis of the patellofemoral joint.

Materials and methods

Of 181 implanted Oxford III prosthesis, 136 (75.1%) could be followed up. The mean age at time of surgery was 65.2 years; the average time of follow-up was 4.2 years. In addition to a physical examination and x-ray, the following scores were obtained: WOMAC (Western Ontario and McMaster Osteoarthritis Index), OKS (Oxford Knee Score), KSS (Knee Society Score), UCLA activity and the Turba score.

Results

The majority of the patients (81%) returned to their sporting activity following knee surgery. Higher complication rates or progression of osteoarthritis associated with sporting activities were not observed. The active patients had significantly higher scores for the OKS, KSS, WOMAC, and UCLA scores. The correct implant position, especially avoiding overcorrection to valgus malalignment, is important for good clinical outcome.

Conclusion

Our results demonstrate that a high degree of patient satisfaction in terms of physical and sporting activity can be achieved using the Oxford III UKA for medial osteoarthritis without an increased risk for complications.

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Interessenskonflikt

M.F. Pietschmann, P. Weber, A. Steinbrück, L. Wohlleb, V. Jansson und P.E. Müller geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Für die retrospektive Auswertung der Patientendaten liegt ein positives Ethikvotum der Ethikkommission der Ludwig-Maximilians-Universität München vor.

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Ludwig-Maximilians-Universität Campus-Großhadern, Marchioninistraße 15, 81377, München, Deutschland

    M.F. Pietschmann, P. Weber, A. Steinbrück, L. Wohlleb, V. Jansson & P.E. Müller

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  1. M.F. Pietschmann
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  2. P. Weber
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  3. A. Steinbrück
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  4. L. Wohlleb
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Correspondence to M.F. Pietschmann.

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Pietschmann, M., Weber, P., Steinbrück, A. et al. Erfahrungen mit medialen monokondylären Prothesen mit mobilem Plateau. Orthopäde 43, 905–912 (2014). https://doi.org/10.1007/s00132-014-3010-y

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