Zusammenfassung
Dieser Beitrag beschreibt die Konzeption und die operative Technik der patientenspezifischen totalen Kniegelenksendoprothetik. Patientenindividuelle Implantate und Instrumente werden auf der Basis einer Computertomographie (CT) des Beins entworfen und hergestellt. Patientenspezifische Einweginstrumente in Form von Bohrschablonen und Schnittblöcken berücksichtigen die anatomischen und mechanischen Achsen des Kniegelenks und vermitteln eine effiziente Pränavigation der knöchernen Schnitte, ohne dass zusätzliche Navigations- oder Balancierungshilfen notwendig sind. Die Operationsplanung erfolgt anhand der CT-Datensätze. Die Implantationstechnik beinhaltet die Teilschritte distale Femurresektion, Tibiaresektion, Balancieren und Femurpräparation, Tibiapräparation, optionaler Patellarückflächenersatz, Testung der Probekomponenten und Implantation der endgültigen Implantatkomponenten. Durch die Verwendung dieses patientenspezifischen Implantatsystems, das nicht nur die personalisierten Einmalinstrumente, sondern auch die individuellen Implantate beinhaltet, wird dem Chirurgen eine endoprothetische Versorgung ermöglicht, die die patientenindividuelle Anatomie und Kniegelenkskinematik in weiten Teilen wiederherstellt. Vorläufige Studien belegen das Konzept und die bisherige Datenlage mit dieser Technologie ist vielversprechend, wenn auch, wie bei einem jungen Implantat üblich, begrenzt. Insbesondere stehen vergleichende Langzeitstudienergebnisse derzeit noch aus.
Abstract
This article describes the concept and surgical technique of patient-specific total knee arthroplasty. Patient-specific implants and instruments are designed and fabricated based on computed tomography (CT) data of the leg. The disposable patient-specific drill guides and cutting-jigs are manufactured taking into consideration the anatomical and biomechanical axes of the knee joint and mediating the efficient pre-navigation of the osseous saw-cuts, without the need for additional navigation or balancing aids. The surgical plan is made on the basis of the CT data. The implantation technique comprises the following steps: distal femoral resection, tibial resection, balancing and femur preparation, tibia preparation, optional patellar resurfacing, trialling of the test components, and implantation of the final components. By using this patient-specific implant system, which includes not only personalized, single-use instruments, but also individualized implants, the surgeon is able to provide endoprosthetic treatment that broadly restores the patient’s own knee anatomy and knee kinematics. Preliminary studies have proven the concept and data on this technology are promising so far; however, like a new implant, they are usually limited. In particular, comparative long-term clinical data are still to come.
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B.M. Holzapfel, L. Sefrin, J. Arnholdt, M. Hoberg und M. Rudert geben an, dass kein Interessenkonflikt besteht. Honorare für Lehrtätigkeiten erfolgten von ConforMIS an A. Steinert.
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Steinert, A.F., Holzapfel, B.M., Sefrin, L. et al. Totalendoprothetischer Kniegelenksersatz. Orthopäde 45, 331–340 (2016). https://doi.org/10.1007/s00132-016-3246-9
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DOI: https://doi.org/10.1007/s00132-016-3246-9