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Erfahrungen mit lateralen unikondylären Prothesen

Experiences with lateral unicondylar prostheses

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Zusammenfassung

Hintergrund

Der unikondyläre Kniegelenkverschleiß betrifft für gewöhnlich häufiger das mediale als das laterale femorortibiale Kompartiment. Lediglich in 5–10 % der Fälle ist das laterale Kompartiment singulär betroffen. Hier stellt der unikompartimentelle Kniegelenkersatz eine sinnvolle Alternative mit wesentlichen Vorteilen gegenüber der Versorgung mit einer bikompartimentellen Oberflächenersatzprothese dar. Zwischen medialem und lateralem femorotibialem Kompartiment gibt es einige wesentliche anatomische und biomechanische Unterschiede, die Auswirkungen auf die Operationstechnik sowie auf das Prothesendesign haben. Prinzipiell werden Prothesen mit mobiler Inlaykomponente („mobile bearing“) von Prothesen mit fixierter Inlaykomponente („fixed bearing“) unterschieden.

Fragestellung

Zusammenstellung klinischer Ergebnisse sowie Überlebensraten nach unikondylärem lateralem Gelenkersatz.

Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zu klinischen Ergebnissen nach Implantation einer lateralen unikondylären Kniegelenkprothese.

Ergebnisse

Der unikondyläre Gelenkersatz mit einer Mobile-bearing-Prothese und domförmigem Tibiaplateau bietet im kurz- bis mittelfristigen Verlauf exzellente klinische Ergebnisse mit einer Reduktion der Luxationsrate auf ein akzeptables Maß. Die Datenlage für Fixed-bearing-Prothesen zeigte heterogene Ergebnisse, nicht zuletzt aufgrund des Einschlusses verschiedener Prothesendesigns und kleiner Patientenkollektive. Dennoch wurden überwiegend gute klinische Ergebnisse mit im Durchschnitt längerem Follow-up berichtet als in den aktuellen Studien zu Mobile-bearing-Prothesen.

Schlussfolgerung

Anhand der aktuell vorliegenden Literatur lässt sich kein differenzierter Unterschied in der Funktion sowie den Überlebensraten zwischen Fixed- und Mobile-bearing-Prothesen und damit keine klare Empfehlung zur Verwendung des jeweiligen Prothesendesign darstellen.

Abstract

Background

Unicompartmental osteoarthritis of the knee joint affects the medial compartment more often than the lateral compartment whereby the lateral is solely affected in only 5–10 % of cases. In this case unicompartmental knee arthroplasty has been shown to be an effective alternative to total knee arthroplasty. There are some basic anatomical and biomechanical differences between the medial and lateral compartment of the knee joint which directly influence modern surgery techniques and implant design. In general, kinematics and design are fundamentally different in mobile-bearing compared to fixed-bearing prostheses.

Objectives

This article presents a summary of outcome and survival rates after unicompartmental knee arthroplasty in the lateral compartment.

Methods

This article is based on a literature search in the PubMed database for clinical results after lateral unicompartmental knee arthroplasty.

Results

The results demonstrate that lateral unicompartmental knee arthroplasty with a mobile-bearing implant and a domed tibial plateau design gives an excellent clinical outcome while reducing the dislocation rate to an acceptable level in the short and mid-term. Published data on the clinical outcome of fixed-bearing lateral unicompartmental knee arthroplasty prostheses revealed heterogeneous results due to the inclusion of different implant designs and relatively small patient cohorts. Nevertheless, most of them demonstrated good clinical results with a longer follow-up than current studies concerning mobile-bearing prostheses.

Conclusion

Based on the published data it is not possible to demonstrate precise differences in clinical outcome and survival rates after mobile-bearing and fixed-bearing unicompartmental knee arthroplasty or to make clear recommendations on the use of each type of prosthesis.

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Einhaltung ethischer Richtlinien

Interessenkonflikt

P.R. Aldinger ist als Berater für Knieprodukte der Firma Biomet tätig. Er führt Hospitation und Vorträge zu deren Produkten durch. T. Gotterbarm ist als Berater für Knieprodukte der Firma Biomet tätig. Er führt Hospitation und Vorträge zu deren Produkten durch. T. Walker gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Orthopädische Klinik Paulinenhilfe, Diakonieklinikum Stuttgart, Rosenbergstraße 38, 70176, Stuttgart, Deutschland

    P. R. Aldinger

  2. Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    T. Walker & T. Gotterbarm

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  1. P. R. Aldinger
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  2. T. Walker
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  3. T. Gotterbarm
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Correspondence to P. R. Aldinger.

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Aldinger, P., Walker, T. & Gotterbarm, T. Erfahrungen mit lateralen unikondylären Prothesen. Orthopäde 43, 913–922 (2014). https://doi.org/10.1007/s00132-014-3021-8

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