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Fortschritte im Weichteilmanagement in der Knieendoprothetik

Einsatz von bildfreien Navigationssystemen

Advances in soft tissue management in total knee arthroplasty

The use of imageless navigation systems

Der Orthopäde volume 35, pages 1066–1072 (2006)Cite this article

Zusammenfassung

Innerhalb der letzten Jahre hat sich die Navigation in der Knieendoprothetik etabliert. Mittlerweile belegt eine Vielzahl von Arbeiten, dass durch den Einsatz von Navigation die Achsrekonstruktion optimiert werden kann. Trotzdem können Achsausreißer nicht vollständig vermieden werden, was die Frage nach den Ursachen aufwirft. Offensichtlich ist die Knieendoprothetik nicht ausschließlich ein knöcherner Eingriff, sondern die Behandlung der Weichteile von außerordentlicher Bedeutung im Hinblick auf eine optimale Gelenkstabilität über den gesamten Bewegungsumfang.

Die Navigation visualisiert intraoperativ die Beinachse und die Gelenkspaltweite und hilft somit dem Operateur, das Weichteilmanagement zu optimieren. In der vorliegenden Arbeit wird dargestellt, inwiefern der anatomische Zugangsweg und die Patellastellung die Weiteilspannung beeinflusst und wie die Navigation den erfahrenen Operateur beim Weichteilrelease im Rahmen von schweren Achsdeformitäten unterstützt.

Abstract

Computer aided surgery has become established in the clinical routine over the past years. There are some very good studies which show that navigation optimizes reconstruction of the leg axis in total knee replacement. The question of why outliers occur in spite of navigation has to be asked. It is clear that total knee replacement is not only a bony procedure, but the soft tissues have an immense influence on postoperative stability of the prosthesis over the full range of movement.

Current navigation systems allow visualization of the leg axis and size of the extension and flexion gap, and support the surgeon during soft tissue management. The current paper shows how the anatomic approach and the position of the patella influence soft tissue tension and support the surgeon during release of soft tissues in severe leg axis deformities.

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Affiliations

  1. Orthopädische Klinik, Universität Regensburg im Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach

    C. Lüring, L. Perlick, M. Tingart & J. Grifka

  2. Klinik für Unfallchirurgie und Orthopädie, Lehrstuhl der Universität Witten-Herdecke, Städtisches Klinikum, Köln-Merheim

    H. Bäthis

Authors
  1. C. Lüring
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  2. L. Perlick
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  3. M. Tingart
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  4. H. Bäthis
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  5. J. Grifka
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Correspondence to C. Lüring.

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Lüring, C., Perlick, L., Tingart, M. et al. Fortschritte im Weichteilmanagement in der Knieendoprothetik. Orthopäde 35, 1066–1072 (2006). https://doi.org/10.1007/s00132-006-0996-9

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  • DOI: https://doi.org/10.1007/s00132-006-0996-9

Schlüsselwörter

  • Knieendoprothetik
  • Weichteilmanagement
  • Bandspannung
  • Navigation
  • Computerassistierte Chirurgie

Keywords

  • Total knee arthroplasty
  • Soft tissue management
  • Ligament tension
  • Navigation
  • Computer assisted surgery