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Laterale Schlittenprothese

„Mobile“ und „fixed bearing“

Lateral unicompartmental knee arthroplasty

Mobile and fixed bearing

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Hintergrund

Bei Vorliegen einer isolierten Osteoarthrose im lateralen tibiofemoralen Gelenk stellt der unikompartimentelle Kniegelenkersatz eine sinnvolle Alternative zur Versorgung mit einer bikompartimentellen Oberflächenersatzprothese dar. Aufgrund anatomischer und biomechanischer Besonderheiten im lateralen femorotibialen Kompartiment bestehen wesentliche Unterschiede im Prothesendesign sowie in der Operationstechnik im Vergleich zum medialen Gelenkersatz. Prinzipiell werden Prothesen mit mobiler („mobile bearing“) und fixierter Inlaykomponente („fixed bearing“) unterschieden.

Fragestellung

Ziel der Arbeit ist eine Übersicht über die unterschiedlichen Techniken, Ergebnisse und Überlebensraten des lateralen unikondylären Gelenkersatzes.

Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche in PubMed zu klinischen Ergebnissen nach Implantation einer lateralen unikondylären Kniegelenkprothese sowie eigenen Erfahrungen mit unterschiedlichen Prothesensystemen.

Ergebnisse

Die aktuelle Studienlage zeigt sowohl bei Verwendung einer Fixed-bearing- als auch einer Mobile-bearing-Prothese gute klinische Ergebnisse mit hoher Patientenzufriedenheit sowie gutem funktionellem Outcome. Hauptgrund für ein Implantatversagen einer Fixed-bearing-Prothese ist die Arthroseprogression im medialen oder femoropatellaren Kompartiment. Die Hauptursache für ein Implantatversagen einer Mobile-bearing-Prothese liegt in der Inlayluxation (1,5–6,6 %). Die Rate ist hierbei deutlich höher als bei Verwendung der Prothese im medialen Kompartiment.

Schlussfolgerung

Anhand der aktuell vorliegenden Literatur lässt sich kein differenzierter Unterschied in der Funktion sowie den Überlebensraten zwischen Fixed- und Mobile-bearing-Prothesen darstellen. Im eigenen Vorgehen empfehlen die Autoren die Verwendung einer Fixed-bearing-Prothese.

Abstract

Background

In isolated lateral osteoarthritis of the knee joint, unicompartmental knee arthroplasty (UKA) is a sensible alternative to total knee arthroplasty. Due to the anatomical and biomechanical specifics of the lateral compartment, there are essential differences in the surgery technique and implant design compared to medial UKA. In general, kinematics and design are fundamentally different in mobile bearing when compared to fixed bearing prostheses.

Objective

A summary of the different techniques, clinical outcome and survival rates of lateral unicompartmental knee arthroplasty is given.

Methods

This article is based on a literature search in the database PubMed for clinical results after lateral unicompartmental knee arthroplasty as well as own experiences with different kinds of prostheses.

Results

Published data reveal good clinical results with high patient satisfaction and good functional outcome for both mobile and fixed bearing prostheses. The main reason for implant failure in fixed bearing prostheses is a progression of medial or patellofemoral osteoarthritis. The main reason for implant failure in mobile bearing prostheses is the dislocation of the bearing (1.5–6.6%). The rate is significantly higher than when using a prosthesis in the medial compartment.

Conclusion

Based on the published data it is not possible to demonstrate precise differences in clinical outcome and survival rates after mobile bearing and fixed bearing unicompartmental knee arthroplasty. Based on our own experiences we recommend the use of a fixed bearing prosthesis.

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Author information

Authors and Affiliations

  1. Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland

    Tilman Walker,  Christian Merle &  Tobias Gotterbarm

  2. Orthopädische Klinik Paulinenhilfe, Diakonieklinikum Stuttgart, Rosenbergstr. 38, 70176, Stuttgart, Deutschland

    Peter R. Aldinger

Authors
  1. Tilman Walker
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  2. Christian Merle
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  3. Tobias Gotterbarm
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  4. Peter R. Aldinger
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Corresponding author

Correspondence to Peter R. Aldinger.

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Interessenkonflikt

P.R. Aldinger ist als Berater für Knieprodukte der Firma Zimmer-Biomet tätig. Er führt Hospitationen und Vorträge zu deren Produkten durch. T. Gotterbarm ist als Berater für Knieprodukte der Firma Zimmer-Biomet tätig. Er führt Hospitationen und Vorträge zu deren Produkten durch. C. Merle und T. Walker geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Teile dieser Arbeit wurden von den Autoren bereits in den Übersichtsartikeln „Erfahrungen mit lateralen unikondylären Prothesen“ [1] sowie „Die laterale Schlittenprothese – eine Herausforderung“ veröffentlicht [42].

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Walker, T., Merle, C., Gotterbarm, T. et al. Laterale Schlittenprothese. Arthroskopie 30, 302–311 (2017). https://doi.org/10.1007/s00142-017-0160-z

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  • DOI: https://doi.org/10.1007/s00142-017-0160-z

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