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Radiologische Diagnostik, Beurteilung und Behandlung des patellofemoralen Schmerzes nach primärer Knieendoprothetik

Radiological findings, evaluation and treatment of patellofemoral pain after total knee arthroplasty

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Zusammenfassung

Die endoprothetische Versorgung des Kniegelenks ist eine Operation mit hohem Zugewinn an Lebensqualität. Dennoch sind je nach Literaturstelle bis zu 50% der Patienten von Schmerzen, Bewegungseinschränkung, Instabilität, Infektion oder anderen Komplikationen betroffen. Insbesondere der patellofemorale Schmerz (PFS) ist eine häufige Komplikation nach primärer Knieendoprothetik und wird je nach Literatur mit 1–50% der Fälle angegeben. Insbesondere der erhöhte retropatellare Anpressdruck und eine schlechte Führung der Patella werden für den PFS verantwortlich gemacht, doch die Ursachen sind vielfältig. Diagnostik und Behandlung sind komplex und sollten strukturiert durchgeführt werden. Nach der Basisdiagnostik schlagen die Autoren daher eine Einteilung in eine der 4 Gruppen vor: 1) Tendinosen, 2) mechanische Probleme, 3) intraartikuläre nichtmechanische Probleme, 4) neurogene/psychische Probleme. Durch die Einteilung in diese verschiedenen Gruppen werden eine effiziente spezielle Diagnostik und die weitere Therapie ermöglicht.

Abstract

Total knee arthroplasty (TKA) is one of the most successful operative procedures over the last decades in orthopedic surgery; however, some patients suffer from pain, limited range of motion, instability, infections or other complications postoperatively. Patellofemoral pain (PFP) in particular is a common problem after TKA and often necessitates revision surgery. Mainly increasing and localized contact pressure and patella maltracking are held responsible for PFP but the reasons vary. Diagnostics and therapy of PFP is not easy to manage and should be treated following a clinical pathway. The authors suggest that patients with PFP should be categorized after basic diagnostic measures according to the suspected diagnosis: (1) tendinosis, (2) mechanical reasons, (3) intra-articular non-mechanical reasons and (4) neurogenic/psychiatric reasons. Efficient application of special diagnostic measures and further therapy is facilitated by this classification.

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Authors and Affiliations

  1. Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland

    H.-R. Springorum, A. Keshmiri, G. Heers, T. Renkawitz, J. Grifka & C. Baier

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  1. H.-R. Springorum
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  2. A. Keshmiri
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  3. G. Heers
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  4. T. Renkawitz
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Correspondence to H.-R. Springorum.

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Dieser aktualisierte Beitrag erschien ursprünglich in „Der Orthopäde“ 10/2011.

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Springorum, HR., Keshmiri, A., Heers, G. et al. Radiologische Diagnostik, Beurteilung und Behandlung des patellofemoralen Schmerzes nach primärer Knieendoprothetik. Radiologe 52, 987–993 (2012). https://doi.org/10.1007/s00117-012-2410-4

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