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Empfehlungen zur unikondylären Schlittenendoprothetik im Wandel der Zeit

Eine aktuelle Bestandsaufnahme

Recommendations for unicondylar knee replacement in the course of time

A current inventory

  • Leitthema
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Zusammenfassung

Hintergrund

Eine höhere Patientenzufriedenheit steht höheren Revisionsraten von unikondylärer Kniegelenksendoprothetik (UKE), verglichen mit totaler Kniegelenksendoprothetik (TKE) gegenüber, ferner persistieren alte „Dogmen“ zu den Indikationen und Kontraindikationen, was sich auch weiterhin in den deutlich unterschiedlichen Fallzahlen der Versorgungen widerspiegelt.

Ziel

Ziel dieser Arbeit ist es, eine Übersicht über die aktuelle Literatur bezüglich 1. Indikation und Kontraindikation (BMI [Body-Mass-Index], Alter, Sport, Arthrose anderer Kompartimente, Ligamentstatus) und 2. den „ewigen Rivalen“ „fixed“ oder „mobile bearing“ bei unikondylärer Schlittenendoprothetik zu geben.

Ergebnisse

Die Wahl des richtigen Patienten bleibt essenziell, wenn auch alle alten „Dogmen“ der Kontraindikationen mittlerweile relativiert oder gar überholt sind. Arthrosen des kontralateralen (beim medialen UKE entsprechend lateral) Kompartments und fortgeschrittene Arthrosen der lateralen Patellafacette bleiben die einzigen persistierenden Kontraindikationen. Hingegen stellen ein hoher BMI, das Alter, die Chondrokalzinose, die mediale Patellafacette und auch ein defektes (insbesondere aber funktionell stabiles) VKB (vorderes Kreuzband) keine Kontraindikation dar. Eine starke Adipositas verantwortet aber eine deutlich höhere Komplikationsrate und vermutlich eine höhere Lockerungsrate. Vielmehr ist die Erfahrung und damit die Anzahl an UKE des einzelnen Operateurs entscheidend für das Outcome, dem auch die Diskussion um mobile oder fixe Inlays komplett unterzuordnen ist. Etwas fehlerverzeihender und „einfacher“ in der Revision erscheint aber das „fixed bearing“.

Schlussfolgerung

Die Indikationen für UKE können also literaturbasiert mit gutem Gewissen deutlich weiter gestellt werden und damit das aktuelle 1:10 Verhältnis UKE:TKE in Deutschland deutlich verschoben werden.

Abstract

Background

A higher patient satisfaction stands in contrast to higher revision rates of unicondylar knee joint endoprosthetics (UKE) compared to total knee joint endoprosthetics (TKE). Furthermore, old “dogmas” regarding indications and contraindications persist, which is still reflected in the significantly different case numbers.

Aim

The aim of this article is to provide an overview of the current literature regarding 1. indication and contraindication (BMI, age, sport, arthrosis of other compartments, ligament status) and 2. the “eternal rival” fixed or mobile bearing for UKE.

Results

The choice of the right patient remains essential, even if all the old “dogmas” of contraindications have been relativized or even outdated. Arthroses of the contralateral (in medial UKE correspondingly lateral) compartment and advanced arthroses of the lateral patella facet remain the only persistent contraindications. In contrast, a high BMI, age, chondrocalcinosis, medial patella facet and a defective (but particularly functionally stable) ACL are not contraindications; however, severe obesity is responsible for a significantly higher complication rate and probably a higher rate of loosening. Rather, the experience and thus the number of UKEs of the individual surgeon is decisive for the outcome, to which the discussion about mobile or fixed inlays must also be completely subordinated.

Conclusion

The indications for UKE can, therefore, be extended with a clear conscience on the basis of literature, and the current 1:10 UKE:TKE ratio in Germany can be shifted significantly.

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Abbreviations

BMI:

Body-Mass-Index

EPRD :

Endoprothesenregister Deutschland

FB :

„Fixed bearing“

HKB :

Hinteres Kreuzband

MB :

„Mobile bearing“

TKE :

Totale Kniegelenksendoprothetik

UKE :

Unikondyläre Kniegelenksendoprothetik

VKB :

Vorderes Kreuzband

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Danksagung

Dank gilt ferner Malin Meier aus Bern sowie Céline Moret und Dominic Mathis aus Basel für die Unterstützung und aktuelle Aufarbeitung von Unterkapiteln.

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Authors and Affiliations

  1. Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland

    J. Beckmann

  2. Kantonsspital Baselland, Liestal, Schweiz

    M. T. Hirschmann

  3. Waldkliniken Eisenberg, Eisenberg, Deutschland

    G. Matziolis

  4. OrthoCentrum Hamburg, Hamburg, Deutschland

    J. Holz

  5. Klinikum rechts der Isar der Technischen Universität München, München, Deutschland

    R. v. Eisenhart-Rothe

  6. IZO – Internationales Zentrum für Orthopädie, ATOS Klinik Heidelberg, Heidelberg, Deutschland

    C. Becher

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  1. J. Beckmann
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  4. J. Holz
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  5. R. v. Eisenhart-Rothe
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J. Beckmann, M.T. Hirschmann, G. Matziolis, J. Holz, R. v. Eisenhardt-Rothe und C. Becher erhalten Honorare von Firmen, die Endoprothesen verkaufen und entwickeln und sind Mitglieder im Vorstand oder im „small implants“ Endoprothetik Komitee der Deutsche Knie Gesellschaft (DKG).

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Beckmann, J., Hirschmann, M.T., Matziolis, G. et al. Empfehlungen zur unikondylären Schlittenendoprothetik im Wandel der Zeit. Orthopäde 50, 104–111 (2021). https://doi.org/10.1007/s00132-020-04054-9

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