Der Orthopäde

, Volume 43, Issue 10, pp 905–912 | Cite as

Erfahrungen mit medialen monokondylären Prothesen mit mobilem Plateau

  • M.F. Pietschmann
  • P. Weber
  • A. Steinbrück
  • L. Wohlleb
  • V. Jansson
  • P.E. Müller
Leitthema
First Online:

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.

Schlüsselwörter

Oberflächenersatz, unikondylärer Gonarthrose, medial Prothesenposition Oxford-Prothese Osteoarthritis 

Experience with medial unicompartmental prostheses with a mobile plateau

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.

Keywords

Knee osteoarthritis Resurfacing implant, unicompartmental Knee prosthesis Prosthesis position Oxford prosthesis 
This is a preview of subscription content, log in to check access.

Notes

Eethischer Richtlinien

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.

Literatur

  1. 1.
    W-Dahl A, Robertsson O, Lidgren L, Miller L, Davidson D, Graves S (2010) Unicompartmental knee arthroplasty in patients aged less than 65. Acta Orthop 81(1):90–94PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Beard DJ, Pandit H, Gill HS, Hollinghurst D, Dodd CA, Murray DW (2007) The influence of the presence and severity of pre-existing patellofemoral degenerative changes on the outcome of the Oxford medial unicompartmental knee replacement. J Bone Joint Surg Br 89(12):1597–1601PubMedCrossRefGoogle Scholar
  3. 3.
    Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840PubMedGoogle Scholar
  4. 4.
    Bruni D, Iacono F, Russo A et al (2010) Minimally invasive unicompartmental knee replacement: retrospective clinical and radiographic evaluation of 83 patients. Knee Surg Sports Traumatol Arthrosc 18(6):710–717PubMedCrossRefGoogle Scholar
  5. 5.
    Clarius M, Hauck C, Seeger JB, Pritsch M, Merle C, Aldinger PR (2010) Correlation of positioning and clinical results in Oxford UKA. Int Orthop 34(8):1145–1151PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 80(1):63–69PubMedCrossRefGoogle Scholar
  7. 7.
    Emerton ME, Burton D (2001) The role of unicompartmental knee replacement. Current Orthopaedics 15(6):406–412CrossRefGoogle Scholar
  8. 8.
    Engh GA, Ammeen DJ (2014) Unicondylar arthroplasty in knees with deficient anterior cruciate ligaments. Clin Orthop Relat Res 472(1):73–77PubMedCrossRefGoogle Scholar
  9. 9.
    Fisher N, Agarwal M, Reuben SF, Johnson DS, Turner PG (2006) Sporting and physical activity following Oxford medial unicompartmental knee arthroplasty. Knee 13(4):296–300PubMedCrossRefGoogle Scholar
  10. 10.
    Gidwani S, Fairbank A (2004) The orthopaedic approach to managing osteoarthritis of the knee. BMJ 329(7476):1220–1224PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Goodfellow JW, Tibrewal SB, Sherman KP, O’Connor JJ (1987) Unicompartmental Oxford Meniscal knee arthroplasty. J Arthroplasty 2(1):1–9PubMedCrossRefGoogle Scholar
  12. 12.
    Griffin T, Rowden N, Morgan D, Atkinson R, Woodruff P, Maddern G (2007) Unicompartmental knee arthroplasty for the treatment of unicompartmental osteoarthritis: a systematic study. ANZ J Surg 77(4):214–221PubMedCrossRefGoogle Scholar
  13. 13.
    Hauptmann SM, Kreul U, Mazoochian F, C VS-P, Jansson V, Muller PE (2005) Influence of patellofemoral osteoarthritis on functional outcome after unicondylar knee arthroplasty. Orthopade 34(11):1088–1083PubMedCrossRefGoogle Scholar
  14. 14.
    Hauptmann SM, Weber P, Glaser C, Birkenmaier C, Jansson V, Muller PE (2008) Free bone cement fragments after minimally invasive unicompartmental knee arthroplasty: an underappreciated problem. Knee Surg Sports Traumatol Arthrosc 16(8):770–775PubMedCrossRefGoogle Scholar
  15. 15.
    Hernigou P, Deschamps G (2004) Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res (423):161–165Google Scholar
  16. 16.
    Heyse TJ, Efe T, Rumpf S et al (2011) Minimally invasive versus conventional unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 131(9):1287–1290PubMedCrossRefGoogle Scholar
  17. 17.
    Hopper GP, Leach WJ (2008) Participation in sporting activities following knee replacement: total versus unicompartmental. Knee Surg Sports Traumatol Arthrosc 16(10):973–979PubMedCrossRefGoogle Scholar
  18. 18.
    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14PubMedGoogle Scholar
  19. 19.
    Institut RK (2006) Gesundheit in Deutschland. Gesundheitsberichtserstattung des Bundes. RKI, BerlinGoogle Scholar
  20. 20.
    Jahromi I, Walton NP, Dobson PJ, Lewis PL, Campbell DG (2004) Patient-perceived outcome measures following unicompartmental knee arthroplasty with mini-incision. Int Orthop 28(5):286–289PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Kang SN, Smith TO, Sprenger De Rover WB, Walton NP (2011) Pre-operative patellofemoral degenerative changes do not affect the outcome after medial Oxford unicompartmental knee replacement: a report from an independent centre. J Bone Joint Surg Br 93(4):476–478PubMedCrossRefGoogle Scholar
  22. 22.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Kendrick BJ, Longino D, Pandit H et al (2010) Polyethylene wear in Oxford unicompartmental knee replacement: a retrieval study of 47 bearings. J Bone Joint Surg Br 92(3):367–373PubMedCrossRefGoogle Scholar
  24. 24.
    Kozinn SC, Scott R (1989) Unicondylar knee arthroplasty. J Bone Joint Surg Am 71(1):145–150PubMedGoogle Scholar
  25. 25.
    Kuipers BM, Kollen BJ, Bots PC et al (2010) Factors associated with reduced early survival in the Oxford phase III medial unicompartment knee replacement. Knee 17(1):48–52PubMedCrossRefGoogle Scholar
  26. 26.
    Ledingham J, Regan M, Jones A, Doherty M (1993) Radiographic patterns and associations of osteoarthritis of the knee in patients referred to hospital. Ann Rheum Dis 52(7):520–526PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Li MG, Yao F, Joss B, Ioppolo J, Nivbrant B, Wood D (2006) Mobile vs. fixed bearing unicondylar knee arthroplasty: a randomized study on short term clinical outcomes and knee kinematics. Knee 13(5):365–370PubMedCrossRefGoogle Scholar
  28. 28.
    Lisowski LA, van den Bekerom MP, Pilot P, van Dijk CN, Lisowski AE (2011) Oxford Phase 3 unicompartmental knee arthroplasty: medium-term results of a minimally invasive surgical procedure. Knee Surg Sports Traumatol Arthrosc 19(2):277–284PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Muller PE, Pellengahr C, Witt M, Kircher J, Refior HJ, Jansson V (2004) Influence of minimally invasive surgery on implant positioning and the functional outcome for medial unicompartmental knee arthroplasty. J Arthroplasty 19(3):296–301PubMedCrossRefGoogle Scholar
  30. 30.
    Newman JH (2000) Unicompartmental knee replacement. Knee 7(2):63–70PubMedCrossRefGoogle Scholar
  31. 31.
    Newman JH, Ackroyd CE, Shah NA (1998) Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicompartmental arthritis. J Bone Joint Surg Br 80(5):862–865PubMedCrossRefGoogle Scholar
  32. 32.
    Palomo JM (2001) Surgical options for middle-aged patients with osteoarthritis of the knee. J Bone Joint Surg Am 83(9):1429PubMedGoogle Scholar
  33. 33.
    Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA, Murray DW (2011) Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg Br 93(2):198–204PubMedCrossRefGoogle Scholar
  34. 34.
    Parratte S, Argenson JN, Dumas J, Aubaniac JM (2007) Unicompartmental knee arthroplasty for avascular osteonecrosis. Clin Orthop Relat Res 464:37–42PubMedGoogle Scholar
  35. 35.
    Pietschmann MF, Wohlleb L, Weber P et al (2013) Sports activities after medial unicompartmental knee arthroplasty Oxford III-what can we expect? Int Orthop 37(1):31–37PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Price AJ, Dodd CA, Svard UG, Murray DW (2005) Oxford medial unicompartmental knee arthroplasty in patients younger and older than 60 years of age. J Bone Joint Surg Br 87(11):1488–1492PubMedCrossRefGoogle Scholar
  37. 37.
    Price AJ, Oppold PT, Murray DW, Zavatsky AB (2006) Simultaneous in vitro measurement of patellofemoral kinematics and forces following Oxford medial unicompartmental knee replacement. J Bone Joint Surg Br 88(12):1591–1595PubMedCrossRefGoogle Scholar
  38. 38.
    Ridgeway SR, McAuley JP, Ammeen DJ, Engh GA (2002) The effect of alignment of the knee on the outcome of unicompartmental knee replacement. J Bone Joint Surg Br 84(3):351–355PubMedCrossRefGoogle Scholar
  39. 39.
    Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286(2):188–195PubMedCrossRefGoogle Scholar
  40. 40.
    Sperner G, Wanitschek P, Benedetto KP, Glotzer W (1990) Late results in patellar fracture. Aktuelle Traumatol 20(1):24–28PubMedGoogle Scholar
  41. 41.
    Svard UC, Price AJ (2001) Oxford medial unicompartmental knee arthroplasty. A survival analysis of an independent series. J Bone Joint Surg Br 83(2):191–194PubMedCrossRefGoogle Scholar
  42. 42.
    Swedish Knee Arthroplasty Register (2009) The Swedish Knee Arthroplasty Register: Annual Report 2009. http://www.myknee.se/en
  43. 43.
    Turba JE, Walsh WM, McLeod WD (1979) Long-term results of extensor mechanism reconstruction. A standard for evaluation. Am J Sports Med 7(2):91–94PubMedCrossRefGoogle Scholar
  44. 44.
    Vorlat P, Putzeys G, Cottenie D et al (2006) The Oxford unicompartmental knee prosthesis: an independent 10-year survival analysis. Knee Surg Sports Traumatol Arthrosc 14(1):40–45PubMedCrossRefGoogle Scholar
  45. 45.
    Vorlat P, Verdonk R, Schauvlieghe H (2000) The Oxford unicompartmental knee prosthesis: a 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 8(3):154–158PubMedCrossRefGoogle Scholar
  46. 46.
    Weber P, Crispin A, Schmidutz F et al (2013) Improved accuracy in computer-assisted unicondylar knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 21(11):2453–2461PubMedCrossRefGoogle Scholar
  47. 47.
    Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC (1998) Assessing activity in joint replacement patients. J Arthroplasty 13(8):890–895PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • M.F. Pietschmann
    • 1
  • P. Weber
    • 1
  • A. Steinbrück
    • 1
  • L. Wohlleb
    • 1
  • V. Jansson
    • 1
  • P.E. Müller
    • 1
  1. 1.Klinik und Poliklinik für Orthopädie, Physikalische Medizin und RehabilitationLudwig-Maximilians-Universität Campus-GroßhadernMünchenDeutschland

Personalised recommendations