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Knieprothesenkinematik

In-vivo-Analysetechniken und Ergebnisse

TKA kinematics

In vivo techniques and results

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Zusammenfassung

Bisher ist es weitgehend unklar, inwieweit die verschiedenen Prothesentypen die physiologischen Bewegungsmuster des Kniegelenks wiederherstellen können. Ziel ist es, die Fluoroskopie und die funktionelle Magnetresonanztomographie (MRT) als bildgebende In-vivo-Techniken zur Bestimmung der Prothesenkinematik, sowie die Ergebnisse dieser Techniken vorzustellen.

Während es sich bei der Fluoroskopie um eine dynamische Untersuchung mittels eines Bildwandlergeräts handelt, erfolgt bei der funktionellen MRT die Bilddatenakquisition in einem offenen MRT mit dem Knie in verschiedenen Flexionsgraden mit und ohne isometrischer Muskelaktivität. In weiteren Bildverarbeitungsschritten erfolgt dann die Analyse der femoropatellaren und -tibialen Kinematik.

Die unter statischen Bedingungen kernspintomographisch gewonnenen Ergebnisse zeigen eine gute Übereinstimmung mit den fluoroskopischen Beobachtungen unter dynamischen Bedingungen. Unabhängig vom Prothesendesign scheinen „typische“ Bewegungsmuster zu existieren. So kann nach Alloarthroplastik des Kniegelenks (TKA) eine vermehrte Außenrotationsstellung des Femurs im Vergleich zu gesunden Knien festgestellt werden. Im Gegensatz dazu ist das Ausmaß der Außenrotationsbewegung während der Kniebeugung vermindert. Die interindividuellen Bewegungsmuster zeigen eine hohe Varianz, wobei sich zwischen den verschiedenen Prothesengruppen Unterschiede feststellen lassen.

Sowohl Knieprothesenmodelle untereinander als auch Knieprothesen vs. gesunde Knie weisen signifikante Veränderungen der femorotibialen und -patellaren Kinematik auf. Dies kann beispielsweise den vermehrten Polyethylenabrieb bestimmter Modelle oder retropatellare Beschwerden erklären. Die vorgestellten Techniken können in Zukunft zu einer fundierteren Einsicht in die Prothesenkinematik beitragen und somit hoffentlich helfen, dass Prothesendesign und damit auch die Standzeit zu verbessern.

Abstract

Until now it remains less clear to what extent the different types of endoprostheses can simulate the physiological motion pattern of the knee joint. The aim of this study was to present fluoroscopy and functional MRI as well as the results of these in vivo imaging techniques for TKA kinematics.

Videofluoroscopy is a dynamic investigation, analyzing the subjects under fluoroscopic surveillance during different activities. Three-dimensional (3D) kinematics were recovered from the two-dimensional fluoroscopic images using a model-fitting technique. Kinematic analysis with functional MRI was performed in an open MR system at different flexion angles with external loads being applied during imaging. Femoropatellar and femorotibial 3D kinematics were analyzed by image postprocessing.

The findings in healthy knees obtained with functional MRI under static conditions are in good agreement with the fluoroscopic outcome under dynamic conditions. In all investigated TKA in the mean an increased external rotated position of the femur relative to the tibia was observed at full extension, while the amount of external rotation during knee flexion was decreased. Although there was great variability among the individuals, differences were observed between the TKA-groups (e.g. posterior stabilized vs PCL retaining).

Significant changes of femorotibial and femoropatellar kinematics were found in TKA compared to healthy knees, which may lead to early aseptic loosening or increased polyethylene wear The presented techniques and results allow for advanced in vivo diagnostics and may help to improve the design of TKA and to enhance the long-term performance.

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Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Danksagungen

Wir möchten unseren Dank der Deutschen Forschungsgemeinschaft sowie der Heinrich und Fritz Riese-Stiftung für Ihre Unterstützung ausdrücken sowie Ulf Henkemeier für seinen Beitrag zu dieser Studie.

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Authors and Affiliations

  1. Asklepios Orthopädische Klinik Lindenlohe, Lindenlohe 18, 92421, Schwandorf, Deutschland

    R. von Eisenhart-Rothe

  2. Institut für klinische und interventionelle Radiologie, JWG-Universität, Frankfurt, Deutschland

    T. Vogl

  3. Institut für Medizinische Informatik und Systemforschung, GSF Forschungszentrum Neuherberg, Oberschleißheim, Deutschland

    K.-H. Englmeier

  4. Colorado Joint Replacement, Denver, USA

    D.A. Dennis

Authors
  1. R. von Eisenhart-Rothe
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  2. T. Vogl
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  3. K.-H. Englmeier
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  4. D.A. Dennis
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Correspondence to R. von Eisenhart-Rothe.

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von Eisenhart-Rothe, R., Vogl, T., Englmeier, KH. et al. Knieprothesenkinematik. Orthopäde 36, 620–627 (2007). https://doi.org/10.1007/s00132-007-1112-5

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