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Periprothetische Frakturen am Kniegelenk

Periprosthetic fractures of the knee joint

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Zusammenfassung

Durch die demographische Entwicklung und die Ausweitung der Indikationsstellung sind periprothetische Frakturen ein zunehmendes Beschwerdebild. Man unterteilt diese Frakturen in perioperative und postoperative Frakturen. Das Risiko für perioperative Frakturen ist insbesondere in der Revisionsprothetik erhöht und betrifft dann häufiger Tibia und Patella. Insgesamt treten jedoch die meisten dieser Frakturen postoperativ auf, durchschnittlich zwei bis vier Jahre nach Primärimplantation. Am häufigsten ist das Femur betroffen, seltener Tibia und Patella. Entscheidend für die Behandlung ist die gründliche Anamnese und Diagnostik, um eventuell gelockerte Prothesenkomponenten zu identifizieren, da hiervon die weitere Behandlungsstrategie maßgebend beeinflusst wird. Ziel ist in jedem Fall, eine übungsstabile oder sogar belastungsstabile Situation zu erreichen, um eine frühe Mobilisation zu gewährleisten. Es ist zu beachten, anatomische Achs- bzw. Rotationsverhältnisse wiederherzustellen.

Abstract

The demographic developments and an increasing number of total knee replacements will lead to more periprosthetic fractures in the future. These fractures can be classified into intraoperative and postoperative. Revisions in particular are associated with a higher incidence of intra-operative fractures, specifically for the tibia and patella. Most fractures occur in the postoperative period with an average of 2–4 years after the primary procedure. Most commonly the femur is involved. The history and clinical examination as well as imaging are crucial for the treatment as loose components would significantly alter the treatment strategy. In this case a revision has to be carefully planned. In the majority of the cases the prosthesis is well fixed especially at the femur. An open reduction internal fixation (ORIF) can then be carried out. A stable situation must be achieved to provide early post-operative mobilization. Also an anatomic reduction should be achieved with correct alignment especially with respect to varus/valgus and rotation. Modern locked implants can provide this with good success also with the possibility of minimally invasive techniques and polyaxial screw positioning. Retrograde intramedullary devices can be a feasible alternative. Similar principles can be used for the tibia whereas the patella can be stabilized with tension band wiring in the case of good bone stock but still remains a problem in case of bad bone stock.

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  1. Klinik für Orthopädische Chirurgie, Kantonspital St.Gallen, Rorschacherstrasse 95, CH-9001, St. Gallen, Schweiz

    J.B. Erhardt & M.S. Kuster

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  1. J.B. Erhardt
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  2. M.S. Kuster
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Correspondence to J.B. Erhardt.

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Erhardt, J., Kuster, M. Periprothetische Frakturen am Kniegelenk. Orthopäde 39, 97–108 (2010). https://doi.org/10.1007/s00132-009-1554-z

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