Zusammenfassung
Hintergrund
Die Entwicklung einer posttraumatischen Gonarthrose ist häufig Folge von Gelenkfrakturen oder Kapsel‑/Bandverletzungen sowie von direkten Knorpel- oder Meniskusschäden. Auch extraartikuläre Frakturen mit Achs- bzw. Rotationsfehlstellungen prädisponieren für eine beschleunigte Arthroseentwicklung. Die Patienten sind zumeist jünger, und es bestehen häufig komplexe Ausgangsbefunde, die das operative Ergebnis wesentlich beeinflussen.
Material und Methode
Die Besonderheiten im Hinblick auf Diagnostik und Therapie werden in diesem Beitrag wiedergegeben. Zudem wird ein Überblick über operative Techniken, Implantatwahl und zu erwartende Ergebnisse gegeben.
Ergebnis und Diskussion
Neben dem präoperativen Infektausschluss stellen die Analyse der Fehlstellung, der Bandstabilität sowie das Ausmaß der knöchernen Defekte wesentliche Faktoren der Operationsplanung dar. Es muss entschieden werden, ob und wann Osteosynthesematerialien entfernt werden müssen, ob eine ein- oder zweizeitige Achskorrektur erfolgen muss und welche Art der Prothese benötigt wird. Zudem spielen das Weichteilmanagement und die Wahl des Zugangs eine wesentliche Rolle.
Schlussfolgerung
Die Behandlung der posttraumatischen Gonarthrose ist deutlich komplexer und komplikationsträchtiger verglichen mit der Primärendoprothetik. Es werden besondere Anforderungen an Vorhaltung und Erfahrung mit verschiedenen Primär- und Revisionssystemen gestellt. Zudem müssen notwendige Operationsschritte wie Umstellungsosteotomien, Rekonstruktion des Streckapparates, lokale oder freie Lappenplastiken (interdisziplinär) vorhanden sein.
Abstract
Background
The development of posttraumatic gonarthritis is often the consequence of joint fractures or capsule/ligament injuries as well as direct cartilage or meniscal damage. Extra-articular fractures with axis or rotational deformities also predispose to accelerated development of osteoarthritis. The patients are mostly younger and usually show complex pathologies that significantly affect the surgical outcome.
Material and methods
The peculiarities with respect to diagnostics and therapy are presented in this article. In addition, an overview of surgical techniques, implant choice and expected results is given.
Results and discussion
In addition to the preoperative exclusion of infections, the analysis of malpositioning, ligament stability and the extent of bony defects are essential factors in surgical planning. It must be decided if and when osteosynthesis materials have to be removed, if an axis correction has to be performed in one stage or two stages and what kind of prosthesis is needed. In addition, soft tissue management and the choice of the appropriate approach are crucial.
Conclusion
The treatment of posttraumatic gonarthritis is a surgical challenge due to the complexity and shows more complications compared to primary arthroplasty. There are special requirements for availability and experience with various primary and revision systems. In addition, the necessary operative steps, such as adjustment osteotomy, reconstruction of the extensor apparatus, local or free flap surgery (interdisciplinary) have to be considered.
Literatur
Brown TD, Johnston RC, Saltzman CL, Marsh JL, Buckwalter JA (2006) Posttraumatic osteoarthritis: a first estimate of incidence, prevalence, and burden of disease. J Orthop Trauma 20(10):739–744. https://doi.org/10.1097/01.bot.0000246468.80635.ef
Houdek MT, Watts CD, Shannon SF, Wagner ER, Sems SA, Sierra RJ (2016) Posttraumatic total knee arthroplasty continues to have worse outcome than total knee arthroplasty for osteoarthritis. J Arthroplasty 31(1):118–123. https://doi.org/10.1016/j.arth.2015.07.022
Nakamae A, Engebretsen L, Bahr R, Krosshaug T, Ochi M (2006) Natural history of bone bruises after acute knee injury: clinical outcome and histopathological findings. Knee Surg Sports Traumatol Arthrosc 14(12):1252–1258. https://doi.org/10.1007/s00167-006-0087-9
Siliski JM, Mahring M, Hofer HP (1989) Supracondylar-intercondylar fractures of the femur. Treatment by internal fixation. J Bone Joint Surg Am. https://doi.org/10.2106/00004623-198971010-00015
Furman BD, Mangiapani DS, Zeitler E et al (2014) Targeting pro-inflammatory cytokines following joint injury: acute intra-articular inhibition of interleukin-1 following knee injury prevents post-traumatic arthritis. Arthritis Res Ther 16(3):R134. https://doi.org/10.1186/ar4591
Wasserstein D, Henry P, Paterson JM, Kreder HJ, Jenkinson R (2014) Risk of total knee arthroplasty after operatively treated tibial plateau fracture a matched-population-based cohort study. J Bone Joint Surg Am. https://doi.org/10.2106/JBJS.L.01691
Klatte TO, Schneider MM, Citak M et al (2013) Infection rates in patients undergoing primary knee arthroplasty with pre-existing orthopaedic fixation-devices. Knee. https://doi.org/10.1016/j.knee.2013.02.004
Szczȩsny G, Olszewski WL, Zagozda M et al (2011) Genetic factors responsible for long bone fractures non-union. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-010-1171-7
Parvizi J, Gehrke T, Chen AF (2013) Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J. https://doi.org/10.1302/0301-620X.95B11.33135
Garbedian S, Sternheim A, Backstein D (2011) Wound healing problems in total knee arthroplasty. Orthopedics. https://doi.org/10.3928/01477447-20110714-42
Zonnenberg CBL, Lisowski LA, van den Bekerom MPJ, Nolte PA (2010) Tuberositas osteotomy for total knee arthroplasty: a review of the literature. J Knee Surg. https://doi.org/10.1055/s-0030-1267472
Meek RMD, Greidanus NV, McGraw RW, Masri BA (2003) The extensile rectus snip exposure in revision of total knee arthroplasty. J Bone Joint Surg. https://doi.org/10.1302/0301-620X.85B8.14214
Stevens J, Clement ND, Patton JT (2018) The extensile medial parapatellar approach to the distal femur and knee: anatomic landmarks and surgical technique. Tech Orthop. https://doi.org/10.1097/bto.0000000000000307
Sah AP, Scott RD (2008) Lateral unicompartmental knee arthroplasty through a medial approach. Surgical technique. J Bone Joint Surg Am. https://doi.org/10.2106/JBJS.H.00257
Hutt J, Dodd M, Bourke H, Bell J (2012) Outcomes of total knee replacement after patellofemoral arthroplasty. J Knee Surg. https://doi.org/10.1055/s-0032-1329233
Feng-Chen K, Kuo-Yao H, Yuan-Kun T, Ming-Chih C (2009) Surgical planning and procedures for difficult total knee arthroplasty. Orthopedics. https://doi.org/10.3928/01477447-20090922-05
Matziolis G, Windisch C (2014) Die posttraumatische Arthrose – eine Herausforderung? Z Orthop Unfall. https://doi.org/10.1055/s-0034-1383092
König C, Sharenkov A, Matziolis G et al (2010) Joint line elevation in revision TKA leads to increased patellofemoral contact forces. J Orthop Res. https://doi.org/10.1002/jor.20952
Kim JT, Han J, Shen QH, Moon SW, Won YY (2018) Morphological patterns of anterior femoral condylar resection in kinematically and mechanically aligned total knee arthroplasty. J Arthroplasty. https://doi.org/10.1016/j.arth.2018.03.063
Manzotti A, Pullen C, Cerveri P, Chemello C, Confalonieri N (2014) Post traumatic knee arthritis: Navigated total knee replacement without hardware removal. Knee. https://doi.org/10.1016/j.knee.2012.06.008
Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am. https://doi.org/10.1007/s00334-010-0250-6
Lonner JH, Siliski JM, Lotke PA (2000) Simultaneous femoral osteotomy and total knee arthroplasty for treatment of osteoarthritis associated with severe extra-articular deformity. J Bone Joint Surg Am. https://doi.org/10.2106/00004623-200003000-00005
Demir B, Özkul B, Saygılı MS, Çetinkaya E, Akbulut D (2018) Deformity correction with total knee arthroplasty for severe knee osteoarthritis accompanying extra-articular femoral deformity: the results are promising. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-4920-8
Holschen M, Lobenhoffer P (2016) Komplikationen kniegelenknaher Umstellungsosteotomien. Orthopade. https://doi.org/10.1007/s00132-015-3199-4
Ghosh KM, Merican AM, Iranpour F, Deehan DJ, Amis AA (2010) The effect of femoral component rotation on the extensor retinaculum of the knee. J Orthop Res. https://doi.org/10.1002/jor.21117
Completo A, Simões JA, Fonseca F, Oliveira M (2008) The influence of different tibial stem designs in load sharing and stability at the cement-bone interface in revision TKA. Knee. https://doi.org/10.1016/j.knee.2008.01.008
De Martino I, De Santis V, Sculco PK, D’Apolito R, Assini JB, Gasparini G (2015) Tantalum cones provide durable mid-term fixation in revision TKA. Clin Orthop Relat Res. https://doi.org/10.1007/s11999-015-4338-2
Shen C, Lichstein PM, Austin MS, Sharkey PF, Parvizi J (2014) Revision knee arthroplasty for bone loss: choosing the right degree of constraint. J Arthroplasty. https://doi.org/10.1016/j.arth.2013.04.042
Bala A, Penrose CT, Seyler TM, Mather RC, Wellman SS, Bolognesi MP (2015) Outcomes after total knee arthroplasty for post-traumatic arthritis. Knee 22(6):630–639. https://doi.org/10.1016/j.knee.2015.10.004
Weiss NG, Parvizi J, Hanssen AD, Trousdale RT, Lewallen DG (2003) Total knee arthroplasty in post-traumatic arthrosis of the knee. J Arthroplast 18(3):23–26. https://doi.org/10.1054/ARTH.2003.50068
Massin P, Bonnin M, Paratte S, Vargas R, Piriou P, Deschamps G (2011) Total knee replacement in post-traumatic arthritic knees with limitation of flexion. Orthop Traumatol Surg Res. https://doi.org/10.1016/j.otsr.2010.06.016
Maratt JD, yu LY, Lyman S, Westrich GH (2015) Predictors of satisfaction following total knee arthroplasty. J Arthroplasty. https://doi.org/10.1016/j.arth.2015.01.039
Blackburn J, Qureshi A, Amirfeyz R, Bannister G (2012) Does preoperative anxiety and depression predict satisfaction after total knee replacement? Knee. https://doi.org/10.1016/j.knee.2011.07.008
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M. Kremer, S.M. Heinz und R. Hoffmann geben an, dass kein Interessenkonflikt besteht.
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Kremer, M., Heinz, S.M. & Hoffmann, R. Endoprothetische Versorgung bei posttraumatischer Gonarthrose. Trauma Berufskrankh 21, 39–47 (2019). https://doi.org/10.1007/s10039-019-0416-0
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DOI: https://doi.org/10.1007/s10039-019-0416-0