Neue Technologien (Robotik, „custom made“) in der unikondylären Endoprothetik – Pro

New technologies (robotics, custom-made) in unicondylar knee arthroplasty—pro

Zusammenfassung

Hintergrund

Die unikondyläre Knieendoprothetik bietet den Vorteil, dass partielle degenerative Veränderungen mit partiellen prothetischen Lösungen adressiert werden können, wodurch möglichst viel des nativen Gelenks, inklusive der Kreuzbänder, erhalten wird. Dem gegenüber stehen die, im Vergleich zur totalen Knieendoprothetik, bis heute immer noch höheren Revisionszahlen. In der Literatur werden als Ursache u. a. sowohl eine ungenügende Passform der Komponenten als auch chirurgische Fehler genannt. Die Verwendung von neuen Technologien, um eine bessere Passform und eine höhere chirurgische Präzision und Reproduzierbarkeit zu erreichen, stellt daher einen vielversprechenden Lösungsansatz dar.

Individuelle Endoprothetik

Die individuelle Endoprothetik bietet den Vorteil, dass die Prothese an die individuelle Anatomie des jeweiligen Patienten angepasst wird und nicht die Anatomie des Patienten an die Prothese, so wie es bei Standardprothesen der Fall ist. Dadurch kann eine optimale Passform der Prothese erreicht und gleichzeitig auf übermäßige Knochenresektionen und Weichteil-Releases verzichtet werden.

Robotik

Die Verwendung von Robotik in der Endoprothetik erleichtert die korrekte Ausführung der Knochenresektionen und die Ausrichtung der Komponenten. Dies gewährleistet eine hohe und reproduzierbare Präzision auch für Chirurgen mit niedrigen Fallzahlen. Studien zur individuellen und roboterassistierten Versorgung berichten von vielversprechenden Ergebnissen, jedoch müssen Langzeitergebnisse hochwertiger randomisierten Studien abgewartet werden, um eine wissenschaftlich fundierte Aussage treffen zu können.

Abstract

Background

Unicondylar knee arthroplasty offers the advantage that partial degenerative changes can be addressed with partial prosthetic solutions, thus preserving as much of the native joint as possible, including the cruciate ligaments. On the other hand, the number of revisions is still higher than for total knee endoprosthetics. In the literature, the causes mentioned are insufficient fit of the components as well as surgical errors. The use of new technologies to achieve a better fit and higher surgical precision and reproducibility, therefore, represents a promising approach.

Individual endoprosthetics

Individual endoprosthetics offers the advantage that the prosthesis is adapted to the individual anatomy of each patient and not the patient’s anatomy to the prosthesis, as is the case with standard prostheses. This allows for an optimal fit of the prosthesis while avoiding excessive bone resections and soft tissue releases.

Robotics

The use of robotics in endoprosthetics makes it easier to correctly perform bone resections and align components. This ensures high and reproducible precision even for surgeons with lower case numbers. Studies on individual unicondylar endoprosthetics and robotics are reporting promising results. However, long-term results of high-quality randomized studies must be awaited in order to make a scientifically sound statement.

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Abbreviations

PSI:

Patientenspezifische Instrumente

UKA:

Unicondylar/Unicompartmental Knee Arthoplasty

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Correspondence to Prof. Dr. med. Johannes Beckmann.

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Interessenkonflikt

T. Calliess, C. Tibesku und J. Beckmann erhalten Beraterhonorare von Firmen, die personalisierte Medizin entwickeln und verkaufen. M. Meier gibt an, dass kein Interessenkonflikt besteht.

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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Meier, M., Calliess, T., Tibesku, C. et al. Neue Technologien (Robotik, „custom made“) in der unikondylären Endoprothetik – Pro. Orthopäde (2020). https://doi.org/10.1007/s00132-020-04058-5

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Schlüsselwörter

  • Partieller Kniegelenkersatz
  • Teilgelenkersatz
  • Personalisierte Medizin
  • Patientenindividuell
  • Unikompartimentell

Keywords

  • Partial knee replacement
  • Personalized medicine
  • Patient specific
  • Customized
  • Unikompartmental