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Patella-in-Place-Balancing

Technik für die Knieprothetik

Patella in Place Balancer

Technique for total knee arthroplasty

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Zusammenfassung

Hintergrund

Die Methode des Gap-Balancing ist für die Einstellung der Femurkomponentenrotation und Beugestabilität in der Primärendoprothetik des Kniegelenkes ein etabliertes und häufig angewendetes Verfahren. Allerdings ist es durch die in der Regel evertierte oder luxierte Patella und durchgeführte Weichteilreleases ungenau und fehleranfällig. Hier wird die Alternativtechnik eines Patella-in-Place-Balancers (PIPB) vorgestellt.

Methode

Zunächst erfolgt die Resektion der Tibia und das Aufbringen einer Basisplatte. Anschließend werden 2 transkondylär verlaufende Pins in sagittaler Richtung in die Femurkondylen eingedreht. Nach Reposition des Streckapparates in die anatomisch Position kann durch sukzessives Eindrehen der Pins der Flexionsspalt aufgespannt werden. An diesem Status erfolgt dann die Ausrichtung der femoralen Schnitte, parallel zur Tibia. Es wird dabei keinerlei Weichteilrelease durchgeführt. Klinische Erfahrungen von über 3000 derart versorgter Patienten werden retrospektiv dargestellt, sowie von einer prospektiven Beobachtungsstudie berichtet.

Ergebnisse

Die Technik des PIPB war für alle primären und sekundären Gonarthrosen – bei erhaltenem Bandapparat – anwendbar. Die ermittelte Revisionsrate lag bei 1,21 %. Nur 2 % der Patienten stellten sich 1 Jahr postoperativ mit einem unbefriedigenden Ergebnis neuerlich vor. In der prospektiven Betrachtung kann nach 6 Monaten eine signifikante Steigerung im KOOS dokumentiert werden (29,3 auf 63,5 Punkte, p < 0,05).

Diskussion

Der Patella-in-Place-Balancer überwindet die wesentliche Limitation der Gap-Balancing Technik hinsichtlich ihrer Ungenauigkeit durch den luxierten Streckapparat. Nach absolvierter Lernkurve erscheint die Technik sicher und reproduzierbar. Die vorläufigen Daten zeigen vielversprechende Ergebnisse.

Abstract

Background

The gap-balancing technique is well established in primary total knee arthroplasty to determine femoral rotation and flexion gap stability. However, it has been reported that the everted or luxated extensor mechanism during this procedure in addition to soft tissue releases performed may cause inaccurate flexion-gap determination and thus result in malpositioning of the femur or instability. In this article the alternative technique of a Patella in Place Balancer (PIPB) with a no tissue release philosophy is introduced.

Method

In this procedure, at first, the tibia resection is performed and a tibia baseplate inserted. Then, two pins are drilled into the sagittal profile of the femoral condyles. After anatomical repositioning of the extensor apparatus the pins are screwed in until the flexion gap is spanned. In this position femoral component orientation is determined parallel to the tibia. We describe the current clinical experience based on a retrospective review of 3,000 patients. Moreover, initial results of a prospective study are outlined.

Results

The PIPB technique was suitable for the treatment of primary and secondary gonarthrosis if the collateral ligaments were intact. The detected revision rate was about 1.21 %. Only 2 % of the treated patients reported back with an unsatisfactory outcome 1 year after surgery. In the prospective survey of 33 patients a significant improvement in the KOOS Score could be documented (29.3 points preoperatively vs. 63.5 postoperatively (p < 0.05)).

Discussion

The PIPB overcomes the major limitation of the gap balancing technique with regard to the inaccuracy caused by the dislocated extensor mechanism. After a learning curve, the technique appears to be safe and reliable. Preliminary data show promising results.

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Authors and Affiliations

  1. Department for Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1–7, 30625, Hannover, Deutschland

    M. Ettinger & T. Calliess

  2. Department for Orthopaedic Surgery, AZ Alma, Eeklo, Belgien

    A. Demurie & I. Ghijselings

  3. Department for Orthopaedic Surgery, AZ Alma, Sijsele, Belgien

    H. Van den Wyngaert

Authors
  1. M. Ettinger
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  2. T. Calliess
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  3. A. Demurie
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  4. H. Van den Wyngaert
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  5. I. Ghijselings
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Correspondence to M. Ettinger.

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Interessenkonflikt

M. Ettinger, T. Callies, A. Demurie, H. Van den Wyngaert und I. Ghijselings sind Berater von Stryker.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Ettinger, M., Calliess, T., Demurie, A. et al. Patella-in-Place-Balancing. Orthopäde 44, 269–274 (2015). https://doi.org/10.1007/s00132-015-3105-0

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