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Update Indikation Teilprothese

Neue Aspekte

Evolving indications for partial knee replacement

New aspects

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Zusammenfassung

Hintergrund

Der teilprothetische Kniegelenksersatz ist eine bewährte Therapie für die fortgeschrittene unikompartimentelle Gonarthrose. Obwohl in den letzten Jahrzehnten durch eine Verbesserung der Implantate und chirurgischen Operationstechniken die Indikation kontinuierlich erweitert werden konnte, wird weltweit aufgrund historischer Präferenzen oft noch der Knietotalprothese der Vorzug gegeben.

Fragestellung

In diesem Artikel werden die Vor- und Nachteile der Knieteilprothese unter Berücksichtigung der Langzeitresultate beleuchtet. Es wird zudem erläutert, wie sich die Indikationskriterien über die letzten Jahrzehnte entwickelt haben und welche neuen Aspekte bei der Patientenselektion durch beispielsweise mögliche Verbesserungen aufgrund des Einsatzes neuer Technologien hinzugekommen sind.

Material und Methoden

Analyse der Langzeitresultate klinischer Studien und Registerdaten unter Beleuchtung der Risikofaktoren für mögliche Versager und ihr Einfluss auf die Entwicklung der Indikationsstellung.

Ergebnisse

Die Langzeitresultate zeigen heutzutage exzellente Standzeiten, welche sich an die Resultate von Knietotalprothesen angleichen. Neue Aspekte für die Erweiterung der Indikationsstellung werden diskutiert für die mögliche Anwendung einer Knieteilprothese bei schwerer Varus-Fehlstellung > 15°, Insuffizienz des vorderen Kreuzbands, jungen aktiven Patienten, vorderem Knieschmerz und/oder patellofemoraler Arthrose, sowie beginnender Arthrose bei degenerativer Meniskuswurzelläsion mit Meniskusextrusion.

Diskussion

Die Indikationsstellung wurde in den letzten Jahren unter Berücksichtigung moderner Erkenntnisse stets erweitert. Die Anwendung fortgeschrittener Technologien kann die Präzision verbessern und chirurgische Fehler minimieren. Weiter wird aufgezeigt, dass die Revisionsraten nicht alleinige Kriterien für den Erfolg sind und dass eine umfassende Betrachtung der klinischen Ergebnisse notwendig ist.

Abstract

Background

Partial knee replacement has proven to be an effective therapy for advanced unicompartmental arthrosis of the knee. Despite continuous advancements in implants and surgical techniques over the past decades, the global preference for total knee arthroplasty still persists for historical reasons.

Objectives

This report aims to illuminate advantages and disadvantages of partial knee replacement considering long-term results, the evolution of indication criteria over recent decades and new aspects in patient selection with potential improvements through emerging technologies.

Material and methods

The analysis involves the examination of long-term results from clinical studies and registry data, highlighting the risk factors for potential failures and their influence on the development of indication criteria.

Results

Present-day long-term results demonstrate excellent prosthetic survival, aligning with outcomes from total knee arthroplasty. New perspectives for expanding indication criteria are discussed, including the possible application of partial knee replacement in cases of severe varus deformity > 15°, anterior cruciate ligament insufficiency, young active patients, anterior knee pain, and/or patellofemoral arthritis, as well as mild radiographic arthritis with degenerative medial meniscus root tear and meniscal extrusion.

Discussion

Indication criteria have consistently expanded in recent years, taking into account modern insights, and the application of advanced technologies can enhance precision and minimize surgical errors. Furthermore, this report emphasizes that revision rates are not the sole criterion for success and underscores the necessity for a comprehensive examination of clinical results.

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Abbreviations

CAS:

„computer assisted surgery“

EPRD :

Endoprothesenregister Deutschland

HKA :

„hip-knee-ankle“

OKS :

Oxford Knee Score

PROM :

„patient-reported outcome measures“

PSI :

„patient specific instrumentation“

RAS :

„robotic assisted surgery“

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Authors and Affiliations

  1. articon Spezialpraxis für Gelenkchirurgie, Berner Prothetikzentrum Salem-Spital, Schänzlistrasse 39, 3013, Bern, Schweiz

    Carlo Theus-Steinmann &  Tilman Calliess

  2. Centre Albert Trillat, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix Rousse, 69004, Lyon, Frankreich

    Sébastien Lustig

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  1. Carlo Theus-Steinmann
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Correspondence to Carlo Theus-Steinmann.

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C. Theus-Steinmann, S. Lustig und T. Calliess geben an, dass kein Interessenkonflikt besteht.

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Theus-Steinmann, C., Lustig, S. & Calliess, T. Update Indikation Teilprothese. Orthopädie 53, 238–245 (2024). https://doi.org/10.1007/s00132-024-04484-9

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