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Unikompartimentelle Kniearthroplastik vs. Umstellungsosteotomie bei medialer Gonarthrose

Unicompartmental knee arthroplasty versus high tibial osteotomy for medial unicompartmental knee osteoarthritis

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Arthroskopie Aims and scope

Zusammenfassung

Die hohe tibiale Osteotomie (HTO) und die unikompartimentelle Kniearthroplastik (UKA) haben ihre eigene Indikation. Sie konkurrieren nur in einem eingeschränkten überlappenden Bereich der Indikation um das gleiche Patientenklientel mit einer medialen Gonarthrose. In vielen Studien konnte belegt werden, dass beide Therapieoptionen gute Ergebnisse erzielen können. Jedoch weisen beide Operationsverfahren individuelle Vorteile auf, die es im klinischen Alltag zu nutzen gilt. Junge, sportlich aktive Patienten mit einem niedrigen medialen Gonarthrosegrad sollten mit einer HTO therapiert werden, um ihren hohen Aktivitätsansprüchen gerecht zu werden. Die UKA hat sich als sicheres Verfahren mit teilweise überlegenen Ergebnissen gegenüber der HTO gerade beim älteren Patienten durchsetzen können. Bei medialer Gonarthrose bieten beide Methoden gegenüber der totalen Kniearthroplastik (TKA) bei richtiger Indikationsstellung klare Vorteile für den Patienten, weshalb sie feste Bestandteile der Therapieoptionen sein müssen. Die radiologische retropatellare Arthrose ohne klinisches Korrelat stellt keine Kontraindikation zur Versorgung mit einer UKA dar.

Abstract

High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) both have their individual indications. There is only one limited group of patients with medial osteoarthritis of the knee for which both forms of treatment might be considered to apply in equal measure. Various studies have shown that both therapy options can yield good results. However, both treatment options bear individual advantages which can be used in the clinical routine. For instance young patients with a high level of physical activity with moderate medial osteoarthritis should undergo HTO surgery in order to stay active for as long as possible. UKA has proved to be a safe procedure, especially for older patients, sometimes even with superior results compared to HTO. Both methods offer advantages for the patient compared to total knee arthroplasty (TKA), provided the indications are correct and must therefore be an integral part of the list of treatment options for medial osteoarthritis of the knee. Radiographic patellofemoral osteoarthritis without clinical symptoms is not a contraindication for UKA.

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Abbreviations

UKA:

Unikompartimentelle Kniearthroplastik

TKA:

Totale Kniearthroplastik

HTO:

Hohe tibiale Osteotomie

Literatur

  1. Bare JV, Gill HS, Beard DJ et al (2006) A convex lateral tibial plateau for knee replacement. Knee 13:122–126

    Article  PubMed  CAS  Google Scholar 

  2. Beard DJ, Pandit H, Gill HS et al (2007) The influence of the presence and severity of pre-existing patellofemoral degenerative changes on the outcome of the Oxford medial unicompartmental knee replacement. J Bone Joint Surg [Br] 89:1597–1601

    Google Scholar 

  3. Bonnin M, Chambat P (2004) Current status of valgus angle, tibial head closing wedge osteotomy in media gonarthrosis. Orthopäde 33:135–142

    Article  PubMed  CAS  Google Scholar 

  4. Brouwer RW, Bierma-Zeinstra SMA, Verhagen AP et al (2008) Osteotomy for treating knee osteoarthritis. The Cochrane Collaboration

  5. Buckup K (Hrsg) (2005) Die unikondyläre Schlittenprothese pro & contra. Steinkopf, Darmstadt

  6. Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg [Am] 75:196–201

    Google Scholar 

  7. Emerton Meab D (2001) The role of unicompartmental knee replacement. Curr Orthop 15:406–412

    Article  Google Scholar 

  8. Engelbrecht E, Zippel J (1973) The sledge prosthesis „model St. Georg“. Acta Orthop Belg 39:203–209

    PubMed  CAS  Google Scholar 

  9. Gidwani S, Fairbank A (2004) The orthopaedic approach to managing osteoarthritis of the knee. BMJ 329:1220–1224

    Article  PubMed  Google Scholar 

  10. Goodfellow JW, O’Connor J (1986) Clinical results of the Oxford knee. Surface arthroplasty of the tibiofemoral joint with a meniscal bearing prosthesis. Clin Orthop Relat Res 205:21–42

    PubMed  Google Scholar 

  11. Goodfellow JW, Tibrewal SB, Sherman KP et al (1987) Unicompartmental oxford meniscal knee arthroplasty. J Arthroplasty 2:1–9

    Article  PubMed  CAS  Google Scholar 

  12. Grelsamer RP (1995) Unicompartmental osteoarthrosis of the knee. J Bone Joint Surg [Am] 77:278–292

    Google Scholar 

  13. Griffin T, Rowden N, Morgan D et al (2007) Unicompartmental knee arthroplasty for the treatment of unicompartmental osteoarthritis: a systematic study. ANZ J Surg 77:214–221

    Article  PubMed  Google Scholar 

  14. Gunther T, Murray D, Miller R et al (1996) Lateral compartment arthroplasty with the Oxford meniscal knee. Knee 3:33–39

    Article  Google Scholar 

  15. Hauptmann SM, Kreul U, Mazoochian F et al (2005) Influence of patellofemoral osteoarthritis on functional outcome after unicondylar knee arthroplasty. Orthopäde 34:1088, 1083–1090

    Article  PubMed  CAS  Google Scholar 

  16. Hauptmann SM, Weber P, Glaser C et al (2008) Free bone cement fragments after minimally invasive unicompartmental knee arthroplasty: an underappreciated problem. Knee Surg Sports Traumatol Arthrosc 16(8):770–775

    Article  PubMed  CAS  Google Scholar 

  17. Ivarsson I, Gillquist J (1991) Rehabilitation after high tibial osteotomy and unicompartmental arthroplasty. A comparative study. Clin Orthop Relat Res 266:139–144

    PubMed  Google Scholar 

  18. Jenny JY, Muller PE, Weyer R et al (2006) Navigated minimally invasive unicompartmental knee arthroplasty. Orthopedics 29:S117–S121

    PubMed  Google Scholar 

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

    Google Scholar 

  20. Langdown AJ, Pandit H, Price AJ et al (2005) Oxford medial unicompartmental arthroplasty for focal spontaneous osteonecrosis of the knee. Acta Orthop 76:688–692

    Article  PubMed  Google Scholar 

  21. Ledingham J, Regan M, Jones A et al (1993) Radiographic patterns and associations of osteoarthritis of the knee in patients referred to hospital. Ann Rheum Dis 52:520–526

    Article  PubMed  CAS  Google Scholar 

  22. Marmor L (1973) The modular knee. Clin Orthop Relat Res 94:242–248

    Article  PubMed  Google Scholar 

  23. Mckeever D (1960) Tibial plateau prosthesis. Clin Orthop Relat Res 18:86–95

    Google Scholar 

  24. Muller PE, Pellengahr C, Witt M et al (2004) Influence of minimally invasive surgery on implant positioning and the functional outcome for medial unicompartmental knee arthroplasty. J Arthroplasty 19:296–301

    Article  PubMed  Google Scholar 

  25. Newman JH (2000) Unicompartmental knee replacement. Knee 7:63–70

    Article  PubMed  Google Scholar 

  26. Ohdera T, Tokunaga J, Kobayashi A (2001) Unicompartmental knee arthroplasty for lateral gonarthrosis: midterm results. J Arthroplasty 16:196–200

    Article  PubMed  CAS  Google Scholar 

  27. Palomo JM (2001) Surgical options for middle-aged patients with osteoarthritis of the knee. J Bone Joint Surg [Am] 83-A:1429

  28. Price AJ, Webb J, Topf H et al (2001) Rapid recovery after oxford unicompartmental arthroplasty through a short incision. J Arthroplasty 16:970–976

    Article  PubMed  CAS  Google Scholar 

  29. Robinson BJ, Rees JL, Price AJ et al (2002) Dislocation of the bearing of the Oxford lateral unicompartmental arthroplasty. A radiological assessment. J Bone Joint Surg [Br] 84:653–657

    Google Scholar 

  30. Rudert M, Galla M, Ackermann B et al (2001) Valgus tibial head reconstruction, monocondylar sled prosthesis or bicondylar gliding surface replacement in therapy of medial gonarthrosis – a cost analysis. Z Orthop Ihre Grenzgeb 139:387–392

    Article  PubMed  CAS  Google Scholar 

  31. Stukenborg-Colsman C, Wirth CJ, Lazovic D et al (2001) High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 7 to 10-year follow-up prospective randomized study. Knee 8:187–194

    Article  PubMed  CAS  Google Scholar 

  32. Tabor OB Jr, Tabor OB (1998) Unicompartmental arthroplasty: a long-term follow-up study. J Arthroplasty 13:373–379

    Article  PubMed  Google Scholar 

  33. Vorlat P, Verdonk R, Schauvlieghe H (2000) The Oxford unicompartmental knee prosthesis: a 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 8:154–158

    Article  PubMed  CAS  Google Scholar 

  34. Weale AE (2001) Comparative outcome after high tibial osteotomy, unicompartmental knee replacement and total knee replacement. Presented at the 1st National Convention of Italian Unicompartmental Knee Arthroplasty Users Group, Milan

  35. Weale AE, Murray DW, Crawford R et al (1999) Does arthritis progress in the retained compartments after „Oxford“ medial unicompartmental arthroplasty? A clinical and radiological study with a minimum ten-year follow-up. J Bone Joint Surg [Br] 81:783–789

    Google Scholar 

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Beratertätigkeit B. Braun Aesculap, Referententätigkeit Biomet.

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  1. Orthopädische Klinik und Poliklinik, Campus Großhadern, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland

    P.E. Müller & M.F. Pietschmann

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  1. P.E. Müller
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  2. M.F. Pietschmann
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Correspondence to P.E. Müller.

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Müller, P., Pietschmann, M. Unikompartimentelle Kniearthroplastik vs. Umstellungsosteotomie bei medialer Gonarthrose. Arthroskopie 22, 199–204 (2009). https://doi.org/10.1007/s00142-008-0484-9

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