Der Unfallchirurg

, Volume 116, Issue 6, pp 537–552 | Cite as

Arthrodese versus Totalendoprothese des oberen Sprunggelenks

CME Zertifizierte Fortbildung

Zusammenfassung

Für die Behandlung der Arthrose des oberen Sprunggelenks (OSG) im Endstadium wird allgemein die Arthrodese des OSG als Goldstandard erachtet. Dies gilt nicht zuletzt aufgrund der hohen Versatilität des Verfahrens sowie der Einsatzmöglichkeiten für zahlreiche Indikationen und Befundkonstellationen. Heute stellt prinzipiell auch die Sprunggelenkendoprothetik unter bestimmten Prämissen eine ernst zu nehmende Alternative dar, da mithilfe beider Verfahren eine relevante Schmerzreduktion sowie ein ähnlicher Funktionsgewinn erzielt werden können und mittlerweile Zehnjahresstandzeiten der Prothesen zwischen 76 und 89 % berichtet werden. Die Revisionsraten beider Techniken werden mit bis zu 10 % angegeben; hierbei unterscheidet sich das Komplikationsspektrum jeweils deutlich voneinander. Bei mehr als zwei Dritteln aller Patienten ist die Genese der Arthrose traumatischen Ursprungs mit relativ niedrigem Altersdurchschnitt und oftmals begleitenden Fehlstellungen, Weichteilschäden oder Instabilitäten des OSG. Eine Wiederherstellung korrekter Achsbeziehungen und die Zentrierung des Talus unter der Tibia sind für beide Verfahren ergebnisrelevant ebenso wie die adäquate Weichteilbalancierung, hier v. a. beim Gelenkersatz. Der korrekten Indikationsstellung und Verfahrenswahl anhand einer ausreichenden präoperativen Diagnostik auch hinsichtlich erforderlicher additiver operativer Maßnahmen kommt somit für das Outcome des Patienten wesentliche Bedeutung zu.

Schlüsselwörter

Osteoarthritis Knochenfehlstellungen Biomechanik Bewegungsumfang, artikulär Funktionswiederherstellung 

Arthrodesis versus total joint replacement of the ankle

Abstract

In general, for the treatment of end-stage osteoarthritis of the ankle joint arthrodesis is considered to be the gold standard based on its versatility and eligibility for numerous indications. Nowadays, total ankle arthroplasty represents a viable alternative to ankle arthrodesis taking into account distinct premises as both procedures provide a calculable reduction of the preoperative pain level and a comparable functional gain. Furthermore, current 10-year-survival rates of total ankle replacement are reported to range between 76 % and 89 %. Revision rates of up to 10 % for both techniques have been reported with manifest differences within the respective spectrum of complications. Due to the fact that more than two thirds of patients suffer from post-traumatic osteoarthritis with a relatively low average of age concomitant malalignment, soft tissue damage or instability may frequently occur. A restoration of anatomic axes and an adequate centering of the talus under the tibia appear to be crucial for the outcome as well as an adequate soft tissue balancing, in particular in total ankle replacement. Thus, the selection of the correct indication and the right choice of treatment on the basis of complete preoperative diagnostics considering necessary additive surgical measures are of paramount importance for the final outcome.

Keywords

Osteoarthritis Bone malalignment Biomechanics Range of motion, articular Recovery of function 

Notes

Danksagung

Der Autor dankt Herrn Thomas Wodetzki, Rostock, für die grafische Gestaltung dieses Beitrags.

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Chirurgische Klinik und Poliklinik, Abteilung für Unfall-, Hand- und WiederherstellungschirurgieUniversitätsmedizin RostockRostockDeutschland

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