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Endoprothetische Versorgung bei posttraumatischer Gonarthrose

Endoprosthetic treatment for posttraumatic gonarthritis

  • Leitthema
  • Published:
Trauma und Berufskrankheit

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.

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Correspondence to M. Kremer.

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M. Kremer, S.M. Heinz und R. Hoffmann geben an, dass kein Interessenkonflikt besteht.

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

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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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