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Sind navigierte Knieendoprothesen tatsächlich präziser implantiert?

Eine Metaanalyse vergleichender Studien

Are computer assisted total knee replacements more accurately placed?

A meta-analysis of comparative studies

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Zusammenfassung

Der Einsatz der computerassistierten Chirurgie auf dem Gebiet der Endoprothetik hat sich insbesondere für die navigationsgestützte Knieprothesenimplantation an vielen Kliniken weltweit etabliert. In einer Analyse der verfügbaren Studien wurden 18 vergleichende Studien zur Präzision nach Knieprothesenimplantation im Vergleich der konventionellen zur navigationsgestützten Technik ermittelt.

In einer Metaanalyse von 13 Studien, die den gleichen Zielbereich der korrekten Implantation mit einer postoperativen Beinachse zwischen 3° Varus und 3° Valgus definierten, wurden insgesamt 1784 Implantationen untersucht. In dem konventionellen Kollektiv konnten 75,6% (654/865) gegenüber 93,9% (863/919) im navigierten Kollektiv innerhalb dieses Bereichs implantiert werden. Die Unterschiede der Behandlungskollektive sind in 11 der 13 Studien statistisch signifikant, der Gruppenunterschied für das Gesamtkollektiv ist hoch signifikant.

Für die Implantationsgenauigkeit der Einzelkomponenten lassen sich Vorteile der Navigationstechnik nicht ebenso eindeutig nachweisen. Vor allem in Studien mit kleineren Fallzahlen sind z. T. keine statistischen Unterschiede der Kollektive nachweisbar. Klinische Ergebnisse werden in den vorliegenden Vergleichsstudien nur begrenzt erhoben, wobei im kurzfristigen klinischen Verlauf keine wesentlichen Unterscheide der Behandlungsgruppen aufgezeigt werden.

Abstract

Computer-assisted surgery (CAS) has become established in many hospitals throughout the world, especially in the form of computer navigation for total knee replacement (TKR). Analysis of the studies available revealed 18 comparative studies examining the precision of implantation of knee endoprostheses following CAS and after implantation by the conventional technique.

In a meta-analysis of 13 studies in which the same safe zone of ±3 from neutral alignment was defined for the leg axis, a total of 1,784 TKR were performed. In the group of patients in whom the conventional technique was used, 75.6% (654/865) of TKR were implanted within the safe zone. In the CAS group 93.9% (863/919) of the prostheses were implanted within the safe zone (p<0.0001). The differences between the groups were statistically significant in 11 of the 13 studies, and the difference between groups for the entire patient population is highly significant.

Only limited clinical results were ascertained in these comparative studies; there were no great differences between the treatment groups in clinical course.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie und Orthopädie, Lehrstuhl der Universität Witten-Herdecke, Städtische Kliniken Köln-Merheim, Ostmerheimer Straße 200, 51109, Köln, Deutschland

    H. Bäthis, S. Shafizadeh, T. Paffrath & C. Simanski

  2. Lehrstuhl für Orthopädie, Universität Regensburg, Asklepios-Klinikum, Bad Abbach, Deutschland

    H. Bäthis, J. Grifka & C. Lüring

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  1. H. Bäthis
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  2. S. Shafizadeh
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  3. T. Paffrath
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  4. C. Simanski
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Correspondence to H. Bäthis.

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Bäthis, H., Shafizadeh, S., Paffrath, T. et al. Sind navigierte Knieendoprothesen tatsächlich präziser implantiert?. Orthopäde 35, 1056–1065 (2006). https://doi.org/10.1007/s00132-006-1001-3

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