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Fokaler Oberflächenersatz und unikompartimenteller Gelenkersatz

Im Grenzbereich zwischen Achskorrektur und Totalendoprothetik

Focal femoral resurfacing and unicompartmental knee replacement

Between osteotomy and total knee replacement

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Zusammenfassung

Insbesondere der unikompartimentelle Ersatz der beiden femorotibialen Kompartimente des Kniegelenkes stellt eine etablierte teilweise gelenkerhaltende Behandlung der lokal begrenzten Gonarthrose dar. Auch kleinere, fokale Implantate und der Oberflächenersatz des Patellofemoralgelenkes zeigen in kleineren Studienkollektiven gute Ergebnisse. Gute Indikationsstellungen und korrekte technische Ausführung sind jedoch Grundvoraussetzungen für reproduzierbar zufriedenstellende Ergebnisse.

Abstract

Unicompartmental knee arthroplasty, especially for both femorotibial compartments of the knee, is an established partly joint-saving treatment option for osteoarthritis of the knee if the disease is limited to one compartment. Even smaller implants or resurfacing of the patellofemoral joint have been shown—in smaller patient collectives—to have the potential to yield good clinical results.

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Abbreviations

FTA:

Femorotibialer Winkel

KOOS :

Knee Injury and Osteoarthritis Outcome Score

PSI :

Patientenspezifische Implantate/Instrumente

UKA :

Unikompartimenteller Kniegelenkersatz

Literatur

  1. Stoddart JC, Dandridge O, Garner A, Cobb J, van Arkel RJ (2020) The compartmental distribution of knee osteoarthritis—a systematic review and meta-analysis. Osteoarthritis Cartilage. https://doi.org/10.1016/j.joca.2020.10.011

    Article  PubMed  Google Scholar 

  2. NJR (2020) Welcome to NJR. https://reports.njrcentre.org.uk/. Zugegriffen: 16. Jan. 2021

  3. Riddle DL, Makowski M (2015) Knee pain patterns and associations with pain and function in persons with or at risk for symptomatic radiographic osteoarthritis: a cross-sectional analysis. J Rheumatol 42:2398–2403

    PubMed  PubMed Central  Google Scholar 

  4. Wright RW, MARS Group (2014) Osteoarthritis classification scales: interobserver reliability and arthroscopic correlation. J Bone Joint Surg Am 96(14):1145–1151

    PubMed  PubMed Central  Google Scholar 

  5. Waldstein W, Jawetz ST, Farshad-Amacker NA et al (2014) Assessment of the lateral patellar facet in varus arthritis of the knee. Knee 21:920–925

    PubMed  Google Scholar 

  6. Abdelaziz H, Balde OM, Citak M et al (2019) Kellgren-Lawrence scoring system underestimates cartilage damage when indicating TKA: preoperative radiograph versus intraoperative photograph. Arch Orthop Trauma Surg 139:1287–1292

    PubMed  Google Scholar 

  7. Keenan OJF, Holland G, Maempel JF et al (2020) Correlations between radiological classification systems and confirmed cartilage loss in severe knee osteoarthritis. Bone Joint J 102-B:301–309

    PubMed  Google Scholar 

  8. Hamilton TW, Choudhary R, Jenkins C et al (2017) Lateral osteophytes do not represent a contraindication to medial unicompartmental knee arthroplasty: a 15-year follow-up. Knee Surg Sports Traumatol Arthrosc 25:652–659

    PubMed  Google Scholar 

  9. Kozinn SC, Scott R (1989) Unicondylar knee arthroplasty. J Bone Joint Surg Am 71:145–150

    CAS  PubMed  Google Scholar 

  10. van der List JP, Chawla H, Zuiderbaan HA, Pearle AD (2016) The role of preoperative patient characteristics on outcomes of unicompartmental knee arthroplasty: a meta-analysis critique. J Arthroplasty 31:2617–2627

    PubMed  Google Scholar 

  11. Deckard ER, Jansen K, Ziemba-Davis M et al (2020) Does patellofemoral disease affect outcomes in contemporary medial fixed-bearing unicompartmental knee arthroplasty? J Arthroplasty 35:2009–2015

    PubMed  Google Scholar 

  12. Sharma L, Song J, Dunlop D et al (2010) Varus and valgus alignment and incident and progressive knee osteoarthritis. Ann Rheum Dis 69:1940–1945

    PubMed  PubMed Central  Google Scholar 

  13. Wei J, Gross D, Lane NE et al (2019) Risk factor heterogeneity for medial and lateral compartment knee osteoarthritis: analysis of two prospective cohorts. Osteoarthritis Cartilage 27:603–610

    CAS  PubMed  Google Scholar 

  14. Hernigou P, Deschamps G (2004) Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res 423:161–165. https://doi.org/10.1097/01.blo.0000128285.90459.12

    Article  Google Scholar 

  15. Zuiderbaan HA, van der List JP, Chawla H et al (2016) Predictors of subjective outcome after medial unicompartmental knee arthroplasty. J Arthroplasty 31:1453–1458

    PubMed  Google Scholar 

  16. Kleeblad LJ, van der List JP, Pearle AD et al (2018) Predicting the feasibility of correcting mechanical axis in large varus deformities with unicompartmental knee arthroplasty. J Arthroplasty 33:372–378

    PubMed  Google Scholar 

  17. Mancuso F, Dodd CA, Murray DW, Pandit H (2016) Medial unicompartmental knee arthroplasty in the ACL-deficient knee. J Orthop Traumatol 17:267–275

    PubMed  PubMed Central  Google Scholar 

  18. Suter L, Roth A, Angst M et al (2019) Is ACL deficiency always a contraindication for medial UKA? Kinematic and kinetic analysis of implanted and contralateral knees. Gait Posture 68:244–251

    PubMed  Google Scholar 

  19. Purcell RL, Cody JP, Ammeen DJ et al (2018) Elimination of preoperative flexion contracture as a contraindication for unicompartmental knee arthroplasty. J Am Acad Orthop Surg 26:e158–e163

    PubMed  Google Scholar 

  20. Huang F, Wu D, Chang J et al (2019) A comparison of mobile- and fixed-bearing unicompartmental knee arthroplasties in the treatment of medial knee osteoarthritis: a systematic review and meta-analysis of 1,861 patients. J Knee Surg. https://doi.org/10.1055/s-0039-1697901

    Article  PubMed  Google Scholar 

  21. Peersman G, Stuyts B, Vandenlangenbergh T et al (2015) Fixed- versus mobile-bearing UKA: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 23:3296–3305

    PubMed  Google Scholar 

  22. Mohammad HR, Bullock GS, Kennedy JA et al (2020) Cementless unicompartmental knee replacement achieves better ten-year clinical outcomes than cemented: a systematic review. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06091-5

    Article  PubMed  PubMed Central  Google Scholar 

  23. Mohammad HR, Matharu GS, Judge A, Murray DW (2020) Comparison of the 10-year outcomes of cemented and cementless unicompartmental knee replacements: data from the national joint registry for England, Wales, Northern Ireland and the Isle of Man. Acta Orthop 91:76–81

    PubMed  Google Scholar 

  24. Weber P, Crispin A, Schmidutz F et al (2013) Improved accuracy in computer-assisted unicondylar knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 21:2453–2461

    PubMed  Google Scholar 

  25. Zhang Z, Zhu W, Zhu L, Du Y (2016) Superior alignment but no difference in clinical outcome after minimally invasive computer-assisted unicompartmental knee arthroplasty (MICA-UKA). Knee Surg Sports Traumatol Arthrosc 24:3419–3424

    PubMed  Google Scholar 

  26. Gaudiani MA, Samuel LT, Kamath AF et al (2020) Robotic-assisted versus manual unicompartmental knee arthroplasty: contemporary systematic review and meta-analysis of early functional outcomes. J Knee Surg. https://doi.org/10.1055/s-0040-1701455

    Article  PubMed  Google Scholar 

  27. Christ AB, Pearle AD, Mayman DJ, Haas SB (2018) Robotic-assisted unicompartmental knee arthroplasty: state-of-the art and review of the literature. J Arthroplasty. https://doi.org/10.1016/j.arth.2018.01.050

    Article  PubMed  Google Scholar 

  28. Naziri Q, Mixa PJ, Murray DP et al (2018) Robotic-assisted and computer-navigated unicompartmental knee arthroplasties: a systematic review. Surg Technol Int 32:271–278

    PubMed  Google Scholar 

  29. Alvand A, Khan T, Jenkins C et al (2018) The impact of patient-specific instrumentation on unicompartmental knee arthroplasty: a prospective randomised controlled study. Knee Surg Sports Traumatol Arthrosc 26:1662–1670

    PubMed  Google Scholar 

  30. Li M, Zeng Y, Wu Y et al (2020) Patient-specific instrument for unicompartmental knee arthroplasty does not reduce the outliers in alignment or improve postoperative function: a meta-analysis and systematic review. Arch Orthop Trauma Surg 140:1097–1107

    PubMed  Google Scholar 

  31. Ollivier M, Parratte S, Lunebourg A et al (2016) The John Insall award: no functional benefit after unicompartmental knee arthroplasty performed with patient-specific instrumentation: a randomized trial. Clin Orthop 474:60–68

    PubMed  Google Scholar 

  32. Schwab PE, Lavand’homme P, Yombi JC, Thienpont E (2015) Lower blood loss after unicompartmental than total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23(12):3494–3500

    PubMed  Google Scholar 

  33. Siman H, Kamath AF, Carrillo N, Harmsen WS, Pagnano MW, Sierra RJ (2017) Unicompartmental knee arthroplasty vs total knee arthroplasty for medial compartment arthritis in patients older than 75 years: comparable reoperation, revision, and complication rates. J Arthroplasty 32(6):1792–1797

    PubMed  Google Scholar 

  34. Drager J, Hart A, Khalil JA, Zukor DJ, Bergeron SG, Antoniou J (2016) Shorter hospital stay and lower 30-day readmission after unicondylar knee arthroplasty compared to total knee arthroplasty. J Arthroplasty 31(2):356–361

    PubMed  Google Scholar 

  35. Liddle AD, Judge A, Pandit H, Murray DW (2014) Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients: a study of data from the national joint registry for England and Wales. Lancet 384(9952):1437–1445

    PubMed  Google Scholar 

  36. Fabre-Aubrespy M, Ollivier M, Pesenti S, Parratte S, Argenson JN (2016) Unicompartmental knee arthroplasty in patients older than 75 results in better clinical outcomes and similar survivorship compared to total knee arthroplasty. A matched controlled study. J Arthroplasty 31(12):2668–2671

    PubMed  Google Scholar 

  37. Lum ZC, Lombardi AV, Hurst JM, Morris MJ, Adams JB, Berend KR (2016) Early outcomes of twin-peg mobile-bearing unicompartmental knee arthroplasty compared with primary total knee arthroplasty. Bone Joint J 98(10):28–33

    PubMed  Google Scholar 

  38. Zuiderbaan HA, van der List JP, Khamaisy S (2017) Unicompartmental knee arthroplasty versus total knee arthroplasty: which type of artificial joint do patients forget? Knee Surg Sports Traumatol Arthrosc 25(3):681–686

    PubMed  Google Scholar 

  39. Burn E, Sanchez-Santos MT, Pandit HG, Hamilton TW, Liddle AD, Murray DW, Pinedo-Villanueva R (2018) Ten-year patient-reported outcomes following total and minimally invasive unicompartmental knee arthroplasty: a propensity score-matched cohort analysis. Knee Surg Sports Traumatol Arthrosc 26(5):1455–1464

    PubMed  Google Scholar 

  40. Wiik AV, Aqil A, Tankard S, Amis AA, Cobb JP (2015) Downhill walking gait pattern discriminates between types of knee arthroplasty: improved physiological knee functionality in UKA versus TKA. Knee Surg Sports Traumatol Arthrosc 23(6):1748–1755

    PubMed  Google Scholar 

  41. Liddle AD, Pandit H, Judge A, Murray DW (2015) Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14,076 matched patients from the national joint registry for England and Wales. Bone Joint J 97:793–801

    PubMed  Google Scholar 

  42. Goodfellow JW, O’Connor JJ, Murray DW (2010) A critique of revision rate as an outcome measure: re-interpretation of knee joint registry data. J Bone Joint Surg Br 92(12):1628–1631

    CAS  PubMed  Google Scholar 

  43. Labek G, Sekyra K, Pawelka W, Janda W, Stöckl B (2011) Outcome and reproducibility of data concerning the Oxford unicompartmental knee arthroplasty: a structured literature review including arthroplasty registry data. Acta Orthop 82:131–135

    PubMed  PubMed Central  Google Scholar 

  44. Hartnett NI, Tregonning RJA, Rothwell A, Hobbs T (2006) Unicompartmental knee arthroplasty—an audit of revisions. The New Zealand experience. J Bone Joint Surg Br 88(II):318

    Google Scholar 

  45. Murray DW, Parkinson RW (2018) Usage of unicompartmental knee arthroplasty. Bone Joint J 100(4):432–435

    PubMed  Google Scholar 

  46. Goodfellow JW, O’Connor JJ, Pandit H, Dodd CA, Murray D (2016) Unicompartmental arthroplasty with the Oxford knee, 2. Aufl. Goodfellow Publishers, Oxford

    Google Scholar 

  47. Li CS, Karlsson J, Winemaker M, Sancheti P, Bhandari M (2014) Orthopedic surgeons feel that there is a treatment gap in management of early OA: international survey. Knee Surg Sports Traumatol Arthrosc 22(2):363–378

    PubMed  Google Scholar 

  48. Fuchs A, Eberbach H, Izadpanah K, Bode G, Sudkamp NP, Feucht MJ (2018) Focal metallic inlay resurfacing prosthesis for the treatment of localized cartilage defects of the femoral condyles: a systematic review of clinical studies. Knee Surg Sports Traumatol Arthrosc 26(9):2722–2732

    PubMed  Google Scholar 

  49. Madry H, Kon E, Condello V, Peretti GM, Steinwachs M, Seil R, Berruto M, Engebretsen L, Filardo G, Angele P (2016) Early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 24(6):1753–1762

    PubMed  Google Scholar 

  50. Dhollander AAM, Almqvist KF, Moens K, Vandekerckhove PJ, Verdonk R, Verdonk P, Victor J (2015) The use of a prosthetic inlay resurfacing as a salvage procedure for a failed cartilage repair. Knee Surg Sports Traumatol Arthrosc 23(8):2208–2212

    PubMed  Google Scholar 

  51. Kirker-Head CA, Van Sickle DC, Ek SW, McCool JC (2006) Safety of, and biological and functional response to, a novel metallic implant for the management of focal full-thickness cartilage defects: preliminary assessment in an animal model out to 1 year. J Orthop Res 24(5):1095–1108

    PubMed  Google Scholar 

  52. Custers RJ, Saris DB, Dhert WJ, Verbout AJ, van Rijen MH, Mastbergen SC, Lafeber FP, Creemers LB (2009) Articular cartilage degeneration following the treatment of focal cartilage defects with ceramic metal implants and compared with microfracture. J Bone Joint Surg Am 91(4):900–910

    CAS  PubMed  Google Scholar 

  53. Becher C, Huber R, Thermann H, Paessler HH, Skrbensky G (2008) Effects of a contoured articular prosthetic device on tibiofemoral peak contact pressure: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 16(1):56–63

    PubMed  Google Scholar 

  54. Becher C, Kalbe C, Thermann H, Paessler HH, Laprell H, Kaiser T, Fechner A, Bartsch S, Windhagen H, Ostermeier S (2011) Minimum 5‑year results of focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee. Arch Orthop Trauma Surg 131(8):1135–1143

    PubMed  Google Scholar 

  55. Holz J, Spalding T, Boutefnouchet T, Emans P, Eriksson K, Brittberg M, Konradsen L, Kosters C, Verdonk P, Hogstrom M, Lind M (2020) Patient-specific metal implants for focal chondral and osteochondral lesions in the knee; excellent clinical results at 2 years. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06289-7

    Article  PubMed  Google Scholar 

  56. Laursen JO (2016) Treatment of full-thickness cartilage lesions and early OA using large condyle resurfacing prosthesis: UniCAP((R)). Knee Surg Sports Traumatol Arthrosc 24(5):1695–1701

    PubMed  Google Scholar 

  57. Laursen JO, Backer Mogensen C, Skjot-Arkil H (2019) HemiCAP knee implants: mid- to long-term results. Cartilage. https://doi.org/10.1177/1947603519894732

    Article  PubMed  Google Scholar 

  58. Laursen JO, Lind M (2017) Treatment of full-thickness femoral cartilage lesions using condyle resurfacing prosthesis. Knee Surg Sports Traumatol Arthrosc 25(3):746–751

    PubMed  Google Scholar 

  59. Laursen JO, Lind M, Mogensen CB, Skjot-Arkil H (2020) A longterm prospective follow-up study of resurfacing miniprosthesis suitable for patients above sixtyfive years with localized cartilage lesions or early osteoarthritis in the knee. J Exp Orthop 7(1):96

    PubMed  PubMed Central  Google Scholar 

  60. Martinez-Carranza N, Rockborn P, Roberts D, Hogstrom M, Stalman A (2020) Successful treatment of femoral chondral lesions with a novel customized metal implant at midterm follow-up. CARTILAGE. https://doi.org/10.1177/1947603520967064

    Article  PubMed  Google Scholar 

  61. Stalman A, Skoldenberg O, Martinez-Carranza N, Roberts D, Hogstrom M, Ryd L (2018) No implant migration and good subjective outcome of a novel customized femoral resurfacing metal implant for focal chondral lesions. Knee Surg Sports Traumatol Arthrosc 26(7):2196–2204

    PubMed  Google Scholar 

  62. Becher C, Cantiller EB (2017) Focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee: 12-year follow-up of two cases and review of the literature. Arch Orthop Trauma Surg 137(9):1307–1317

    CAS  PubMed  Google Scholar 

  63. Pascual-Garrido C, Daley E, Verma NN, Cole BJ (2017) A comparison of the outcomes for cartilage defects of the knee treated with biologic resurfacing versus focal metallic implants. Arthroscopy 33(2):364–373

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Kniechirurgie und Sportverletzungen, Orthopädie Sonnenhof, Salvisbergstrasse 4, 3006, Bern, Schweiz

    Philipp Henle

  2. Orthopädische Klinik Paulinenhilfe, Diakonie-Klinikum Stuttgart, Stuttgart, Deutschland

    Matthias J. Feucht

  3. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland

    Matthias J. Feucht

  4. Klinik für Orthopädie, Uniklinikum Magdeburg, Magdeburg, Deutschland

    Christian Stärke

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Correspondence to Philipp Henle.

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P. Henle, M.J. Feucht und C. Stärke geben 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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Henle, P., Feucht, M.J. & Stärke, C. Fokaler Oberflächenersatz und unikompartimenteller Gelenkersatz. Orthopäde 50, 387–394 (2021). https://doi.org/10.1007/s00132-021-04105-9

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