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Vorderer Knieschmerz nach Knie‑TEP-Implantation

Ursachen, Diagnostik und Therapie

Anterior knee pain after total knee arthroplasty

Causes, diagnosis and treatment

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Zusammenfassung

Hintergrund

Der vordere Knieschmerz ist eine der häufigsten Komplikationen nach endoprothetischer Versorgung des Kniegelenks. Seine Häufigkeit wird in der Literatur mit bis zu 30 % angegeben.

Ziel

Das Ziel unserer Arbeit ist eine systematische Literaturrecherche der Ursachen und Therapieoptionen bei vorderem Knieschmerz.

Ursachen

Es werden patienten- und kniespezifische Gründe diskutiert, die Bedeutung des Prothesendesigns und der Operationstechnik untersucht und funktionelle sowie neurologische Ursachen analysiert. Instabilitäten, eine Druckerhöhung im Patellofemoralgelenk oder ein Patellamaltracking können klinisch als vorderer Knieschmerz imponieren. Hervorgerufen werden sie oft durch mechanische Ursachen, wie eine Fehlrotation der Prothesenkomponenten, Offset-Fehler, Bandinsuffizienzen oder eine Patella baja. Typische funktionelle Gründe für einen vorderen Knieschmerz sind pathologische Gangmuster, Muskelimbalancen oder ein dynamischer Knievalgus. Differenzialdiagnostisch sind diese von infektiösen und entzündlichen Ursachen ebenso zu differenzieren, wie von einem Weichteilimpingement und neurologischen Erkrankungen.

Behandlung

Ein differenzierter Diagnose- und Behandlungs-Algorithmus wird präsentiert. In vielen Fällen existieren konservative Behandlungsmöglichkeiten. Bei mechanischen Ursachen ist jedoch häufig eine operative Revision erforderlich.

Abstract

Background

Anterior knee pain is one of the most common complications after total knee arthroplasty. An incidence of up to 30 % has been reported in peer-reviewed studies.

Target

The purpose of this study was to systematically review the literature and to identify determinants that have been analyzed with regard to anterior knee pain.

Causes

Patient- and knee-specific characteristics, prosthetic designs and operative techniques are addressed as well as functional and neurologic determinants. Instability, increased contact pressure in the patellofemoral joint and patella maltracking due to malrotation of components, offset errors, ligament insufficiencies or patella baja are mechanical reasons for anterior knee pain. Functional causes include pathologic gait patterns, quadriceps imbalance and dynamic valgus. They have to be differentiated from infectious and inflammatory causes as well as soft tissue impingement, arthrofibrosis and neurologic diseases.

Treatment

A differentiated treatment algorithm is recommended. Often conservative treatment options exist, however, particularly with most mechanical causes revision surgery is necessary.

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Authors and Affiliations

  1. Klinik für Orthopädie, Uniklinikum Aachen, RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Deutschland

    R. Michalik, B. Rath &  M. Tingart

  2. Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Deutschland

    H.-R. Springorum

  3. Orthopädische Klinik, Klinikum Dortmund, Dortmund, Deutschland

    C. Lüring

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  1. R. Michalik
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Correspondence to M. Tingart.

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R. Michalik, B. Rath, H.-R. Springorum, C. Lüring und M. Tingart geben an, dass kein Interessenkonflikt besteht.

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Michalik, R., Rath, B., Springorum, HR. et al. Vorderer Knieschmerz nach Knie‑TEP-Implantation. Orthopäde 45, 386–398 (2016). https://doi.org/10.1007/s00132-016-3256-7

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