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Knieendoprothetik: Intraoperative Komplikationen

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AE-Manual der Endoprothetik

Part of the book series: Springer Reference Medizin ((SRM))

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Zusammenfassung

Liegen nach der Operation die Symptome einer Peronaeusirritation vor, sollte die Extremität nicht zu fest verbunden werden. Die Lagerung erfolgt in 40° Flexion. Aus rechtlichen Gründen empfiehlt sich die Hinzuziehung eines Neurologen und gegebenenfalls auch eines Neurochirurgen. Eine weitere Bildgebung zur Beurteilung eines Hämatoms ist aus gutachterlicher Sicht von Vorteil. Klinisch sollte ein Kompartmentsyndrom abgegrenzt werden. Bei Patienten mit bekannt schlechtem Gefäßstatus sollte die präoperative Abklärung in Zusammenarbeit mit einem Gefäßchirurgen erfolgen. Die Verwendung einer Blutsperre sollte bei diesen Patienten unterbleiben. Die meist metaphysären intraoperativen Frakturen können durch Osteosynthese (Schrauben, winkelstabile Platte) fixiert und sollten nach Möglichkeit mittels Stemaugmentation geschützt werden. Problematisch erscheint die längere Ruhigstellung des Kniegelenkes. Bei kleineren, zunächst intraoperativ nicht entdeckten Frakturen sollte nach Möglichkeit nur die Fraktur geschient werden (z. B. Sarmiento-Gips) und die Beweglichkeit des Kniegelenkes weiter ermöglicht werden. Kommt es intraoperativ zu einer Verletzung einer der beiden Seitenbänder, sollte die Möglichkeit gegeben sein, auf eine nicht bandgeführte Prothese umzusteigen. Bei Verletzungen der Patellasehne stellt die Rekonstruktion den sichersten Weg dar. Dies kann durch eine Plastik mithilfe der Semitendinosussehne erfolgen.

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Author information

Authors and Affiliations

  1. Departmentleiter Hüft- und Knieendoprothetik, LKH Murtal/Stolzalpe, Stolzalpe, Österreich

    Martin Pietsch

  2. LKH Murtal/Stolzalpe, Stolzalpe, Österreich

    Siegfried Hofmann

Authors
  1. Martin Pietsch
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  2. Siegfried Hofmann
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Corresponding author

Correspondence to Martin Pietsch .

Editor information

Editors and Affiliations

  1. CMSC, Campus Mitte, Charite Berlin, Berlin, Berlin, Deutschland

    Carsten Perka

  2. Orthopädische Klinik Braunschweig, Herzog-Elisabeth-Hospital, Braunschweig, Niedersachsen, Deutschland

    Karl-Dieter Heller

Section Editor information

  1. Waldkliniken Eisenberg, Eisenberg, Deutschland

    Georg Matziolis

  2. Klinik für Endoprothetik, Knie- und Hüftchirurgie; Department für Bewegungschirurgie, Vivantes Klinikum Spandau, Berlin, Deutschland

    Tilman Pfitzner

  3. Orthopädische Universitätsklinik Ulm am RKU, Ulm, Deutschland

    Heiko Reichel

  4. Universitätsklinikum Bonn, Direktor der Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Bonn, Deutschland

    Dieter Christian Wirtz

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Pietsch, M., Hofmann, S. (2022). Knieendoprothetik: Intraoperative Komplikationen. In: Perka, C., Heller, KD. (eds) AE-Manual der Endoprothetik. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-55485-2_38-1

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  • DOI: https://doi.org/10.1007/978-3-662-55485-2_38-1

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-55485-2

  • Online ISBN: 978-3-662-55485-2

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