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Kniegelenksnahe Umstellungsosteotomien des Erwachsenen

Knee realignment osteotomy in adults

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Zusammenfassung

Hintergrund

Heutzutage ist die kniegelenknahe Osteotomie bei Achsfehlstellungen als operatives Verfahren zum Gelenkerhalt aus dem orthopädisch-chirurgischem Spektrum nicht mehr wegzudenken. Dabei sind die genaue Lokalisation und Analyse der Deformität entscheidend, um durch eine geeignete Osteotomie wieder physiologische Belastungsverhältnisse des gesamten Beines zu erzeugen.

Verfahren

So hat sich vor allem die mediale „Open-wedge“-Osteotomie als Standardverfahren zur Therapie der durch ein Varus-Malalignment verursachten Gonarthrose etabliert. Des Weiteren zeigt auch die varisierende „Closed-wedge“-Osteotomie am distalen Femur sehr gute Langzeitergebnisse. Grundsätzlich handelt es sich bei kniegelenknahen Osteotomien um kausale Korrekturen, bei denen biologische und mechanische Aspekte beachtet werden müssen. So entscheiden die korrekte Indikationsstellung, die Beachtung von Risikofaktoren und die operative Technik über den langfristigen Erfolg des Eingriffs. Die Lehrmeinung der femoral bedingten Valgusdeformität und die dadurch entstehende laterale Arthrose gilt es dagegen nach neuestem Kenntnisstand zu überdenken.

Abstract

Background

Nowadays, osteotomy near the knee joint for axial deformities has become an indispensable surgical procedure for joint preservation in the orthopaedic-surgical spectrum. The exact localization and analysis of the deformity are crucial to restoring physiological loading conditions of the entire leg by means of a suitable osteotomy.

Procedures

Thus, above all, the medial “open-wedge” osteotomy has established itself as a standard procedure for the treatment of gonarthrosis caused by varus malalignment. Furthermore, the varus closed-wedge osteotomy of the distal femur also shows very good long-term results. Basically, osteotomies close to the knee are causal corrections in which biological and mechanical aspects must be taken into account. Thus, the correct indication, attention to risk factors, and surgical technique determine the long-term success of the procedure. The doctrine of femoral valgus deformity and the resulting lateral arthrosis, on the other hand, must be reconsidered according to the latest knowledge.

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Abbreviations

DFO:

„Distal femoral osteotomy“

HTO :

„High tibial osteotomy“

JLCA :

„Joint line convergence angle“

mFTW :

Mechanischer femorotibialer Winkel

mLDFW :

Mechanischer lateraler distaler Femurwinkel

mMPTW :

Mechanischer medialer proximaler Tibiawinkel

TBVA :

„Tibial bone varus angle“

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Authors and Affiliations

  1. Deutsches Zentrum für Orthopädie, Waldkliniken Eisenberg mit Professur für Orthopädie der FSU Jena, Klosterlausnitzer Straße 81, 07607, Eisenberg, Deutschland

    Markus Heinecke, Eric Röhner, Stefan Pietsch & Georg Matziolis

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  1. Markus Heinecke
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Correspondence to Markus Heinecke.

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M. Heinecke, E. Röhner, S. Pietsch und G. Matziolis 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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Heinecke, M., Röhner, E., Pietsch, S. et al. Kniegelenksnahe Umstellungsosteotomien des Erwachsenen. Orthopäde 50, 570–577 (2021). https://doi.org/10.1007/s00132-021-04119-3

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