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Knochendefektmanagement in der Revisionsknieendoprothetik

Bone defect management in revision knee arthroplasty

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Zusammenfassung

Hintergrund

Im Jahr 2019 wurden in Deutschland laut EPRD bei 124.677 Erstimplantationen am Kniegelenk 14.462 Folgeoperationen durchgeführt. Das entspricht einem Anteil von 11,6 %. Die Wahrscheinlichkeit einer erneuten Wechseloperation nach Erstwechsel für Knieprothesen liegt laut EPRD bei zirka 15 %. Der häufigste Grund ist immer noch die aseptische Lockerung mit 23,9 %.

Ursachen

Eine mögliche Ursache könnte die erschwerte Fixation von Revisionsprothesen sein. Bei unzureichender Knochenqualität reicht eine zementfreie oder zementierte diaphysäre Verankerung der Prothese oft nicht aus, um eine ausreichende Fixation zu gewährleisten. In der Regel richtet sich das Defektmanagement und die Fixation des Implantates nach der Defektsituation und der Knochenqualität. Dabei sollten Revisionsprothesen nach dem Fixationsprinzip von Jones et al. in mindestens 2 Zonen ausreichend fixiert werden.

Techniken

Zur stabilen Verankerung eines Revisionsimplantates gibt es verschiedene Techniken. Neben der zementierten oder zementfreien Stielverankerung sind Knochenallografts, Wedges und Blöcke und in den letzten Jahren Cones und Sleeves zunehmend populär geworden. In der vorliegenden Arbeit sollen daher die verschiedenen Optionen einer stabilen Verankerung eines Revisionsimplantates dargestellt und bewertet werden. Zusätzlich soll das klinische und radiologische Outcome von Cones vs. Sleeves beim Knochendefektmanagement in der Revisionsknieendoprothetik verglichen werden.

Abstract

Background

In 2019, 124,677 primary total knee arthroplasties and 14,462 revision TKA were performed in Germany. This corresponds to a percentage of 11.6%. According to the EPRD, the probability of further revision surgery after the first exchange operation is around 15%.

Reasons

The most common reason for revision surgery is still aseptic loosening with 23.9%. One possible cause could be the difficult fixation of revision total knee arthroplasty. If the bone quality is insufficient, cement-free or cemented diaphyseal anchoring of the prosthesis is often not sufficient to ensure adequate fixation. As a rule, defect management and fixation of the implant are based on the defect situation and the quality of the bone. Therefore, revision total knee arthroplasties based on the fixation principle of Jones et al. should be sufficiently fixed in at least 2 zones.

Techniques

There are various techniques for stable anchoring of revision implants. In addition to cemented or cementless stem anchoring, bone allografts, wedges and blocks and, in recent years, cones and sleeves have become increasingly popular. In the present work, the various options for a stable anchoring of revision implants are presented and evaluated. In addition, the clinical and radiological outcome of cones vs. sleeves in bone defect management in revision knee arthroplasty will be compared.

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Abbreviations

AORI:

Anderson Orthopedic Research Institut

EPRD :

Endoprothesenregister Deutschland

IBG :

„Impaction bone grafting“

PMMA :

Polymethylmethacrylat

TEP :

Totalendoprothese

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Authors and Affiliations

  1. Deutsches Zentrum für Orthopädie, Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Deutschland

    Eric Röhner, Markus Heinecke & Georg Matziolis

  2. Universitätsklinik Jena, Jena, Deutschland

    Eric Röhner

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  1. Eric Röhner
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Correspondence to Eric Röhner.

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E. Röhner, M. Heinecke 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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Röhner, E., Heinecke, M. & Matziolis, G. Knochendefektmanagement in der Revisionsknieendoprothetik. Orthopäde 50, 1004–1010 (2021). https://doi.org/10.1007/s00132-021-04181-x

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