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Das dritte Kompartiment bei der Knieendoprothetik

Von Denervierung bis Ersatz, welche Therapie ist die richtige?

The third compartment in knee endoprosthetics

From denervation to replacement, which therapy is correct?

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Zusammenfassung

Tibiofemorale Arthrosen sind regelmäßig mit arthrotischen Veränderungen des Patellofemoralgelenks vergesellschaftet. Es herrscht kein Konsens darüber, welches Vorgehen im Rahmen eines Kniegelenkersatzes in Bezug auf die Kniescheibe angemessen ist. Sowohl der nichtselektive primäre Ersatz wie auch ein selektiver oder sekundärer Ersatz der Kniescheibe werden gegenwärtig praktiziert. Die aktuelle Literatur erlaubt keine klare Wertung in dieser Hinsicht, beide Vorgehensweisen sind zu rechtfertigen. Ebenso mangelt es an Belegen, dass die häufig praktizierte peripatellare Denervierung substanziellen Einfluss auf das Ergebnis hat. Neue diagnostische Modalitäten wie u. a. die Single Photon Emission Computed Tomography/CT (SPECT/CT) werden möglicherweise dazu beitragen, gezielt in solchen Fällen einen Ersatz der Patellarückfläche anzustreben, in denen der Patient davon tatsächlich profitiert.

Abstract

Involvement of the patellofemoral compartment is common in osteoarthritis of the knee but to date there is no consensus as to the most appropriate approach concerning the patella. Both general non-selective resurfacing as well as selective or secondary resurfacing are currently accepted. However, despite abundant studies on the subject no clear conclusions can be drawn from the available evidence. There are arguments in favour of either approach. Accordingly, no strong evidence can be found to support peripatellar denervation. With the advent of new diagnostic modalities for the assessment of knee osteoarthritis, such as single photon emission computed tomography/CT (SPECT/CT), a more selective approach to patellar resurfacing with a potentially improved outcome might become possible.

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  1. Orthopädische Universitätsklinik Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland

    C. Stärke, E.F. Röpke & C.H. Lohmann

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  1. C. Stärke
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  2. E.F. Röpke
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  3. C.H. Lohmann
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Correspondence to C. Stärke.

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Stärke, C., Röpke, E. & Lohmann, C. Das dritte Kompartiment bei der Knieendoprothetik. Orthopäde 40, 896–901 (2011). https://doi.org/10.1007/s00132-011-1778-6

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