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Die posttraumatische Arthrose des jungen Patienten

Therapieoptionen vor der Endoprothese

Post-traumatic arthritis in the young patient

Treatment options before the endoprosthesis

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Zusammenfassung

Hintergrund

Die Therapie der posttraumatischen Ellenbogengelenksarthrose des jüngeren Patienten ist schwierig. Die Totalendoprothese des Ellenbogens ist bei diesem Patientenkollektiv soweit wie möglich hinauszuzögern. Am Anfang der Therapie steht die konservative Behandlung, bei Versagen derselben können chirurgische Maßnahmen diskutiert werden.

Behandlungsziel

Ziel der chirurgischen Therapie sollte es sein, einen funktionellen Bewegungsumfang bei akzeptablen Schmerzen zu gewährleisten, ohne dabei zukünftige Therapieoptionen zu verbauen.

Therapie

Patienten mit endgradigem Extensions- und/oder Flexionsschmerz und Bewegungseinschränkung eignen sich für das arthroskopische oder offene Debridement. Patienten mit fortgeschrittener Arthrose und Schmerzen über dem gesamten Bewegungsbogen, die noch zu jung für eine Ellenbogenprothese sind, kann die Interpositionsarthroplastik oder auch Arthrodese angeboten werden. Die Arthrodese führt durch den Verlust des Extension- und Flexionsbogens zu massiven Einschränkungen im täglichen Leben. Sie wird heute daher nur noch in absoluten Ausnahmesituationen empfohlen. Die Interpositionsarthroplastik stellt eine sinnvolle Option für den jüngeren Patienten mit stabilem Ellenbogen ohne wesentliche knöcherne Defekte dar, die einen stabilen, funktionellen Bewegungsbogen bei akzeptablem Schmerzniveau gewährleisten kann. Dabei bewahrt sie die Revisionsmöglichkeiten der erneuten Interpositionsarthroplastik sowie den Rückzug zur Ellenbogentotalendoprothese. Die (Teil-)Endoprothetik des Ellenbogens gehört ebenfalls zu den Therapieoptionen der Ellenbogenarthrose, ist jedoch nicht Bestandteil dieser Übersichtsarbeit.

Abstract

Background

In the young patient, treatment of post-traumatic elbow arthritis remains difficult. Total elbow arthroplasty must be delayed for as long as possible. Therapy starts with nonoperative treatment. If this fails, operative options can be discussed.

Treatment aim

The aim of surgery is to provide a functional range of motion with acceptable pain without obstructing future treatment options.

Therapy

Patients with pain at terminal extension and/or flexion may benefit from arthroscopic or open debridement. Patients with advanced osteoarthritis and pain throughout the complete range of motion, who are too young for total elbow arthroplasty, are offered interposition arthroplasty or arthrodesis. Arthrodesis of the elbow leads to significant restrictions in daily life due to the complete loss of extension/flexion. Therefore, arthrodesis is only offered as treatment in exceptional circumstances. Interposition arthroplasty is a reasonable option for the young patient without significant bony defects, which may provide a stable, functional flexion arc with an acceptable pain level. Interposition arthroplasty preserves the revision options of re-interposition arthroplasty as well as the withdrawal to total elbow arthroplasty. Partial and total elbow arthroplasty are treatment options of elbow arthritis but are not subjects of this article.

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Authors and Affiliations

  1. Arcus Sportklinik, ARCUS Kliniken, Rastatter Str. 17–19, 75179, Pforzheim, Deutschland

    K. J. Burkhart &  B. Hollinger

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  1. K. J. Burkhart
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  2. B. Hollinger
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Correspondence to K. J. Burkhart.

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Interessenkonflikt

K. J. Burkhart und B. Hollinger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Burkhart, K.J., Hollinger, B. Die posttraumatische Arthrose des jungen Patienten. Orthopäde 45, 832–843 (2016). https://doi.org/10.1007/s00132-016-3326-x

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