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Kniegelenknahe Osteotomie bei unikompartimenteller Gonarthrose

Wo stehen wir heute?

Osteotomy near the knee joint in unicompartmental knee osteoarthritis

What is the current situation?

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Die kniegelenknahe Osteotomie ist ein evidenzbasiertes chirurgisches Verfahren zur Therapie der unikompartimentellen Gonarthrose, mit dem sich die Symptome Schmerz und Funktion verbessern lassen. Die 10-Jahres-Überlebensraten für die Osteotomie an der proximalen Tibia variieren zwischen 85,4 % und 91,6 %, die 10-Jahres-Überlebensraten für die Osteotomie am distalen Femur zwischen 65 % und 87 %. Die Wahl des Operationsverfahrens (femoral, tibial, schließend, öffnend) soll anhand patientenspezifischer Faktoren (Ort der Deformität, Patellastand, Beinlänge usw.) bestimmt werden. Essenziell ist eine sorgfältige präoperative Planung. Bei erheblichen Deformitäten sollte sogar eine Doppelosteotomie in Erwägung gezogen werden. Zu neueren Entwicklungen, wie z. B. patientenspezifischen Schnittblöcken, sind weitere Studien erforderlich. Die Stabilität winkelstabiler Implantate erlaubt am Tibiakopf eine funktionelle Nachbehandlung mit früher Belastung innerhalb der ersten 2 Wochen, sofern keine Risikofaktoren für die Knochenheilung vorhanden sind. Nach Osteotomie am distalen Femur sehen die meisten Empfehlungen eine 6‑ bis 8‑wöchige Teilbelastung vor. Die Optimierung perioperativer Prozesse durch die Verwendung von Tranexamsäure und der lokalen Infiltrationsanästhesie verringert den intra- und postoperativen Blutverlust, führt zu weniger postoperativen Hämatomen und geringerem postoperativem Schmerz. So können die Patienten nach kniegelenknaher Osteotomie rascher mobilisiert werden. Möglicherweise können auch Komplikationen vermieden werden (z. B. Thrombose).

Abstract

Osteotomy near the knee joint is an evidence-based surgical procedure for the treatment of unicompartmental knee osteoarthritis, which can improve pain and function. The 10-year survival rates for high tibial osteotomy (HTO) vary between 85.4% and 91.6% and the 10-year survival rates for distal femoral osteotomy (DFO) vary between 65% and 87%. The choice of surgical procedure (femoral, tibial, closing, opening) should be determined on the basis of patient-specific factors (location of the deformity, patellar position, leg length, etc.). Careful preoperative planning is essential. In cases of extreme deformity, a double osteotomy can be considered to ensure a horizontally aligned postoperative joint line. For recent developments, such as patient-specific cutting blocks, further studies are required. The stability of angle-stable implants allows functional follow-up treatment of the tibial head with early load bearing within the first 2 weeks when risk factors for bone healing are absent. After DFO most recommendations propose partial weight bearing for 6–8 weeks. Optimization of perioperative processes by the use of tranexamic acid and local infiltration anesthesia reduces intraoperative and postoperative blood loss, leads to fewer postoperative hematomas and less postoperative pain. This means that patients can be mobilized more rapidly after osteotomy near the knee joint and complications can probably also be reduced (e.g. thrombosis).

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Authors and Affiliations

  1. Sportklinik Berlin und Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin Grunewald, Caspar-Theyß-Straße 27–31, 14193, Berlin, Deutschland

    W Petersen, S. Bierke & M. Häner

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  1. W Petersen
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Interessenkonflikt

W. Petersen erhielt Beraterhonorare durch die Firma AAP Implantate, Berlin. S. Bierke und M. Häner geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Petersen, W., Bierke, S. & Häner, M. Kniegelenknahe Osteotomie bei unikompartimenteller Gonarthrose. Arthroskopie 33, 244–255 (2020). https://doi.org/10.1007/s00142-020-00378-y

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  • DOI: https://doi.org/10.1007/s00142-020-00378-y

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