Indikationen und Grenzindikationen zum medialen unikondylären Gelenkersatz mit mobiler Inlay-Komponente

 

 Buy Article Permissions and Reprints

Zusammenfassung

Bei Patienten mit isolierter anteromedialer Gonarthrose besteht, neben der Möglichkeit zur Implantation einer bikondylären Oberflächenersatzprothese, die Möglichkeit zum unikondylären Gelenkersatz. Voraussetzungen hierfür sind funktionell intakte Kreuz- sowie Kollateralbänder, intakte Knorpelverhältnisse im lateralen Kompartiment sowie eine intraoperative Beugefähigkeit von min. 100°. Als Kontraindikationen gelten eine Instabilität oder Kontraktur der Kollateral- sowie der Kreuzbänder, eine Varusabweichung, je nach Autor > 10° oder 15°, ein Streckdefizit > 15°, eine intraoperative Beugefähigkeit < 100° sowie ein Z. n. valgisierender Umstellungsosteotomie. Ebenso gelten aufgrund der zu erwartenden progressiven Gelenkdestruktion eine entzündliche Arthropathie sowie ein viertgradiger Knorpelschaden im lasttragenden zentralen Anteil des lateralen Kompartiments als Kontraindikationen. Unter Einhaltung dieser Kriterien konnten exzellente funktionelle Langzeitergebnisse sowie Implantatüberlebensraten erreicht werden. Eine Ausweitung dieser Kriterien, insbesondere bei Kreuzbandinsuffizienz oder vorbestehender valgisierender Umstellungsosteotomie, sollte Einzelfällen vorbehalten bleiben unter sorgfältiger Nutzen- und Risikoabwägung sowie ausführlicher Aufklärung des Patienten über die fehlenden Langzeitdaten und möglicherweise erhöhten Komplikationsraten. Wurden zur Indikationsstellung zusätzlich lange Zeit die Kriterien nach Kozinn und Scott angewandt, welche sich jedoch ursprünglich auf Prothesen mit fixierter Inlay-Komponente beschränkten, können diese bei Prothesen mit mobiler Inlay-Komponente weitestgehend vernachlässigt werden. Kriterien wie Alter, Aktivität, Gewicht, das Vorliegen einer Chondrokalzinose sowie das Vorhandensein eines vorderen Knieschmerzes haben keinen Einfluss auf das klinische Outcome sowie die Langzeitüberlebensrate der Prothese.

Abstract

Beside the possibility of bicondylar knee replacement, patients with isolated anteromedial osteoarthritis also have the possibility of unicondylar knee replacement. Therefore some requirements are essential such as functionally intact cruciate and collateral ligaments, intact cartilage in the lateral compartment and an intraoperative flexion of more than 100°. An instability or contracture of the cruciate or collateral ligaments, a varus deformity more than 15°, a flexion deformity of more than 15°, an intraoperative flexion less than 100° as well as failed upper tibial osteotomy are seen as contraindications. In addition, a rheumatoid arthritis and a full thickness cartilage defect in the central part of the lateral compartment are seen as a contraindication because of the risk of a progression of the disease. With respect to these contraindications, excellent functional outcome and survival rates could be demonstrated in the long term. An expansion of these criteria, especially in patients with an insufficiency of the cruciate ligaments or after failed upper tibial osteotomy should only be done in certain cases after careful assessment of the benefits and risks. These patients should be informed about the lack of long-term results and the higher risk of complications. Quite commonly, the criteria of Kozinn and Scott are used for patient selection. These criteria were originally established for fixed-bearing prosthesis and have no relevance on mobile-bearing prosthesis. Criteria such as age, level of activity, weight, chondrocalcinosis and anterior knee pain have no effect on the clinical outcome or the long-term survival of a mobile-bearing prosthesis.

• Literatur

• 1 Ahlbäck S. Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) 1968; Suppl. 277: S7-S72
  PubMedGoogle Scholar
• 2 Aldinger PR, Clarius M, Murray DW et al. [Medial unicompartmental knee replacement using the “Oxford Uni” meniscal bearing knee]. Orthopade 2004; 33: 1277-1283
  CrossrefPubMedGoogle Scholar
• 3 Hurst JM, Berend KR. Mobile-bearing unicondylar knee arthroplasty: the Oxford experience. Clin Sports Med 2014; 33: 105-121
  CrossrefPubMedGoogle Scholar
• 4 Gotterbarm T. Schlittenprothesen mit mobilem Polyethyleninlay. In: Jerosch J, Franz A, Aldinger P, Hrsg. Knieteilersatz. Köln: Deutscher Ärzte-Verlag; 2012: 141-146
  Google Scholar
• 5 Matziolis G, Tohtz S, Gengenbach B et al. Mobile vs. feste Plattform bei unikondylärem Kniegelenkersatz. Orthopäde 2007; 36: 1106-1112
  CrossrefPubMedGoogle Scholar
• 6 Argenson JN, OʼConnor JJ. Polyethylene wear in meniscal knee replacement. A one to nine-year retrieval analysis of the Oxford knee. J Bone Joint Surg Br 1992; 74: 228-232
  Google Scholar
• 7 Goodfellow J, OʼConnor J, Dodd C et al. Unicompartmental Arthroplasty with the Oxford Knee. Oxford: Oxford University Press; 2006
  Google Scholar
• 8 Kretzer JP, Jakubowitz E, Reinders J et al. Wear analysis of unicondylar mobile bearing and fixed bearing knee systems: a knee simulator study. Acta Biomater 2011; 7: 710-715
  CrossrefPubMedGoogle Scholar
• 9 Dennis DA, Komistek RD. Mobile-bearing total knee arthroplasty: design factors in minimizing wear. Clin Orthop Relat Res 2006; 452: 70-77
  CrossrefPubMedGoogle Scholar
• 10 McEwen HM, Barnett PI, Bell CJ et al. The influence of design, materials and kinematics on the in vitro wear of total knee replacements. J Biomech 2005; 38: 357-365
  CrossrefPubMedGoogle Scholar
• 11 Goodfellow JW, OʼConnor J. Clinical results of the Oxford knee. Surface arthroplasty of the tibiofemoral joint with a meniscal bearing prosthesis. Clin Orthop Relat Res 1986; 205: 21-42
  PubMedGoogle Scholar
• 12 Goodfellow J, OʼConnor J. The mechanics of the knee and prosthesis design. J Bone Joint Surg Br 1978; 60?B: 358-369
  PubMedGoogle Scholar
• 13 Goodfellow JW, Kershaw CJ, Benson MK et al. The Oxford Knee for unicompartmental osteoarthritis. The first 103 cases. J Bone Joint Surg Br 1988; 70: 692-701
  PubMedGoogle Scholar
• 14 White SH, Ludkowski PF, Goodfellow JW. Anteromedial osteoarthritis of the knee. J Bone Joint Surg Br 1991; 73: 582-586
  Google Scholar
• 15 Harman MK, Markovich GD, Banks SA et al. Wear patterns on tibial plateaus from varus and valgus osteoarthritic knees. Clin Orthop Relat Res 1998; 352: 149-158
  PubMedGoogle Scholar
• 16 Goodfellow J, OʼConnor J, Dodd C, Murray D. Design of the Oxford Knee. In: Goodfellow J, OʼConnor J, Dodd C, Murray D, eds. Unicompartmental Arthroplasty with the Oxford Knee. Oxford: Oxford University Press; 2006: 7-29
  Google Scholar
• 17 Deschamps G, Lapeyre B. [Rupture of the anterior cruciate ligament: a frequently unrecognized cause of failure of unicompartmental knee prostheses. Apropos of a series of 79 Lotus prostheses with a follow-up of more than 5 years]. Rev Chir Orthop Reparatrice Appar Mot 1987; 73: 544-551
  PubMedGoogle Scholar
• 18 Kozinn SC, Marx C, Scott RD. Unicompartmental knee arthroplasty. A 4.5–6-year follow-up study with a metal-backed tibial component. J Arthroplasty 1989; 4 (Suppl.) S1-S10
  CrossrefPubMedGoogle Scholar
• 19 Palumbo BT, Scott RD. Diagnosis and indications for treatment of unicompartmental arthritis. Clin Sports Med 2014; 33: 11-21
  CrossrefPubMedGoogle Scholar
• 20 Stern SH, Becker MW, Insall JN. Unicondylar knee arthroplasty. An evaluation of selection criteria. Clin Orthop Relat Res 1993; 286: 143-148
  PubMedGoogle Scholar
• 21 Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am 1989; 71: 145-150
  PubMedGoogle Scholar
• 22 Ritter MA, Faris PM, Thong AE et al. Intra-operative findings in varus osteoarthritis of the knee. An analysis of pre-operative alignment in potential candidates for unicompartmental arthroplasty. J Bone Joint Surg Br 2004; 86: 43-47
  PubMedGoogle Scholar
• 23 Murray DW, Goodfellow JW, OʼConnor JJ. The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg Br 1998; 80: 983-989
  CrossrefPubMedGoogle Scholar
• 24 Halder A. Indikation zur unikondylären Knieendoprothese. In: Jerosch J, Franz A, Aldinger P, Hrsg. Knieteilersatz. Köln: Deutscher Ärzte-Verlag; 2012: 107-114
  Google Scholar
• 25 Gotterbarm T. Indikationen und Kontraindikationen der mobile bearing Schlittenprothese. In: Jerosch J, Franz A, Aldinger P, Hrsg. Knieteilersatz. Köln: Deutsche Ärzte-Verlag; 2012: 146-153
  Google Scholar
• 26 Aldinger PR, Walker T, Gotterbarm T. [Experiences with lateral unicondylar prostheses]. Orthopade 2014; 43: 913-922
  CrossrefPubMedGoogle Scholar
• 27 Gibson PH, Goodfellow JW. Stress radiography in degenerative arthritis of the knee. J Bone Joint Surg Br 1986; 68: 608-609
  PubMedGoogle Scholar
• 28 Keyes GW, Carr AJ, Miller RK et al. The radiographic classification of medial gonarthrosis. Correlation with operation methods in 200 knees. Acta Orthop Scand 1992; 63: 497-501
  CrossrefPubMedGoogle Scholar
• 29 Kendrick BJ, Rout R, Bottomley NJ et al. The implications of damage to the lateral femoral condyle on medial unicompartmental knee replacement. J Bone Joint Surg Br 2010; 92: 374-379
  PubMedGoogle Scholar
• 30 Goodfellow J, OʼConnor J. The anterior cruciate ligament in knee arthroplasty. A risk-factor with unconstrained meniscal prostheses. Clin Orthop Relat Res 1992; 276: 245-252
  PubMedGoogle Scholar
• 31 Saxler G, Temmen D, Bontemps G. [AMC unicondylar prosthesis]. Orthopade 2004; 33: 1267-1276
  CrossrefPubMedGoogle Scholar
• 32 Price AJ, Dodd CA, Svard UG et al. Oxford medial unicompartmental knee arthroplasty in patients younger and older than 60 years of age. J Bone Joint Surg Br 2005; 87: 1488-1492
  PubMedGoogle Scholar
• 33 Kort NP, van Raay JJ, van Horn JJ. The Oxford phase III unicompartmental knee replacement in patients less than 60 years of age. Knee Surg Sports Traumatol Arthrosc 2007; 15: 356-360
  CrossrefPubMedGoogle Scholar
• 34 Berend KR, Lombardi jr. AV, Adams JB. Obesity, young age, patellofemoral disease, and anterior knee pain: identifying the unicondylar arthroplasty patient in the United States. Orthopedics 2007; 30: 19-23
  PubMedGoogle Scholar
• 35 Engh GA. Orthopaedic crossfire–can we justify unicondylar arthroplasty as a temporizing procedure? in the affirmative. J Arthroplasty 2002; 17: 54-55
  CrossrefPubMedGoogle Scholar
• 36 Saragaglia D, Estour G, Nemer C et al. Revision of 33 unicompartmental knee prostheses using total knee arthroplasty: strategy and results. Int Orthop 2009; 33: 969-974
  CrossrefPubMedGoogle Scholar
• 37 Jarvenpaa J, Kettunen J, Miettinen H et al. The clinical outcome of revision knee replacement after unicompartmental knee arthroplasty versus primary total knee arthroplasty: 8–17 years follow-up study of 49 patients. Int Orthop 2010; 34: 649-653
  CrossrefPubMedGoogle Scholar
• 38 Walker T, Gotterbarm T, Bruckner T et al. Total versus unicompartmental knee replacement for isolated lateral osteoarthritis: a matched-pairs study. Int Orthop 2014; 38: 2259-2264
  Google Scholar
• 39 Fisher N, Agarwal M, Reuben SF et al. Sporting and physical activity following Oxford medial unicompartmental knee arthroplasty. Knee 2006; 13: 296-300
  CrossrefPubMedGoogle Scholar
• 40 Pietschmann MF, Wohlleb L, Weber P et al. Sports activities after medial unicompartmental knee arthroplasty Oxford III-what can we expect?. Int Orthop 2013; 37: 31-37
  CrossrefPubMedGoogle Scholar
• 41 Hopper GP, Leach WJ. Participation in sporting activities following knee replacement: total versus unicompartmental. Knee Surg Sports Traumatol Arthrosc 2008; 16: 973-979
  CrossrefPubMedGoogle Scholar
• 42 Walker T, Gotterbarm T, Bruckner T et al. Return to sports, recreational activity and patient-reported outcomes after lateral unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; [Epub ahead of print]
  PubMedGoogle Scholar
• 43 Pandit H, Jenkins C, Gill HS et al. Unnecessary contraindications for mobile-bearing unicompartmental knee replacement. J Bone Joint Surg Br 2011; 93: 622-628
  PubMedGoogle Scholar
• 44 Murray DW, Pandit H, Weston-Simons JS et al. Does body mass index affect the outcome of unicompartmental knee replacement?. Knee 2013; 20: 461-465
  CrossrefPubMedGoogle Scholar
• 45 Kuipers BM, Kollen BJ, Bots PC et al. Factors associated with reduced early survival in the Oxford phase III medial unicompartment knee replacement. Knee 2010; 17: 48-52
  CrossrefPubMedGoogle Scholar
• 46 Cepni SK, Arslan A, Polat H et al. Mid-term results of Oxford Phase 3 unicompartmental knee arthroplasty in obese patients. Acta Orthop Traumatol Turc 2014; 48: 122-126
  CrossrefPubMedGoogle Scholar
• 47 Hauptmann SM, Kreul U, Mazoochian F et al. [Influence of patellofemoral osteoarthritis on functional outcome after unicondylar knee arthroplasty]. Orthopade 2005; 34: 1088 1090-1093
  CrossrefPubMedGoogle Scholar
• 48 Beard DJ, Pandit H, Ostlere S et al. Pre-operative clinical and radiological assessment of the patellofemoral joint in unicompartmental knee replacement and its influence on outcome. J Bone Joint Surg Br 2007; 89: 1602-1607
  CrossrefPubMedGoogle Scholar
• 49 Beard DJ, Pandit H, Gill HS et al. The influence of the presence and severity of pre-existing patellofemoral degenerative changes on the outcome of the Oxford medial unicompartmental knee replacement. J Bone Joint Surg Br 2007; 89: 1597-1601
  CrossrefPubMedGoogle Scholar
• 50 Kang SN, Smith TO, Sprenger De Rover WB et al. Pre-operative patellofemoral degenerative changes do not affect the outcome after medial Oxford unicompartmental knee replacement: a report from an independent centre. J Bone Joint Surg Br 2011; 93: 476-478
  PubMedGoogle Scholar
• 51 Munk S, Odgaard A, Madsen F et al. Preoperative lateral subluxation of the patella is a predictor of poor early outcome of Oxford phase-III medial unicompartmental knee arthroplasty. Acta Orthop 2011; 82: 582-588
  CrossrefPubMedGoogle Scholar
• 52 Price AJ, Svard U. A second decade lifetable survival analysis of the Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res 2011; 469: 174-179
  CrossrefPubMedGoogle Scholar
• 53 Svard UC, Price AJ. Oxford medial unicompartmental knee arthroplasty. A survival analysis of an independent series. J Bone Joint Surg Br 2001; 83: 191-194
  CrossrefPubMedGoogle Scholar
• 54 Hernigou P, Pascale W, Pascale V et al. Does primary or secondary chondrocalcinosis influence long-term survivorship of unicompartmental arthroplasty?. Clin Orthop Relat Res 2012; 470: 1973-1979
  CrossrefPubMedGoogle Scholar
• 55 Verdonk R, Cottenie D, Almqvist KF et al. The Oxford unicompartmental knee prosthesis: a 2–14 year follow-up. Knee Surg Sports Traumatol Arthrosc 2005; 13: 163-166
  CrossrefPubMedGoogle Scholar
• 56 Weale AE, Murray DW, Crawford R et al. Does arthritis progress in the retained compartments after ‘Oxford’ medial unicompartmental arthroplasty? A clinical and radiological study with a minimum ten-year follow-up. J Bone Joint Surg Br 1999; 81: 783-789
  CrossrefPubMedGoogle Scholar
• 57 Pandit H, Jenkins C, Barker K et al. The Oxford medial unicompartmental knee replacement using a minimally-invasive approach. J Bone Joint Surg Br 2006; 88: 54-60
  PubMedGoogle Scholar
• 58 Price AJ, Waite JC, Svard U. Long-term clinical results of the medial Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res 2005; 435: 171-180
  PubMedGoogle Scholar
• 59 Lewold S, Goodman S, Knutson K et al. Oxford meniscal bearing knee versus the Marmor knee in unicompartmental arthroplasty for arthrosis. A Swedish multicenter survival study. J Arthroplasty 1995; 10: 722-731
  CrossrefPubMedGoogle Scholar
• 60 Robertsson O, Knutson K, Lewold S et al. The routine of surgical management reduces failure after unicompartmental knee arthroplasty. J Bone Joint Surg Br 2001; 83: 45-49
  CrossrefPubMedGoogle Scholar
• 61 Vorlat P, Putzeys G, Cottenie D et al. The Oxford unicompartmental knee prosthesis: an independent 10-year survival analysis. Knee Surg Sports Traumatol Arthrosc 2006; 14: 40-45
  CrossrefPubMedGoogle Scholar
• 62 Langdown AJ, Pandit H, Price AJ et al. Oxford medial unicompartmental arthroplasty for focal spontaneous osteonecrosis of the knee. Acta Orthop 2005; 76: 688-692
  CrossrefPubMedGoogle Scholar
• 63 Marmor L. Unicompartmental arthroplasty for osteonecrosis of the knee joint. Clin Orthop Relat Res 1993; 247-253
  PubMedGoogle Scholar
• 64 Plancher KD, Dunn AS, Petterson SC. The anterior cruciate ligament-deficient knee and unicompartmental arthritis. Clin Sports Med 2014; 33: 43-55
  CrossrefPubMedGoogle Scholar
• 65 Pandit H, Beard DJ, Jenkins C et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty. J Bone Joint Surg Br 2006; 88: 887-892
  CrossrefPubMedGoogle Scholar
• 66 Weston-Simons JS, Pandit H, Jenkins C et al. Outcome of combined unicompartmental knee replacement and combined or sequential anterior cruciate ligament reconstruction: a study of 52 cases with mean follow-up of five years. J Bone Joint Surg Br 2012; 94: 1216-1220
  PubMedGoogle Scholar
• 67 Pandit H, Van Duren BH, Gallagher JA et al. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty: in vivo kinematics. Knee 2008; 15: 101-106
  CrossrefPubMedGoogle Scholar
• 68 Rees JL, Price AJ, Lynskey TG et al. Medial unicompartmental arthroplasty after failed high tibial osteotomy. J Bone Joint Surg Br 2001; 83: 1034-1036
  CrossrefPubMedGoogle Scholar
• 69 Vorlat P, Verdonk R, Schauvlieghe H. The Oxford unicompartmental knee prosthesis: a 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 2000; 8: 154-158
  CrossrefPubMedGoogle Scholar
• 70 Valenzuela GA, Jacobson NA, Buzas D et al. Unicompartmental knee replacement after high tibial osteotomy: invalidating a contraindication. Bone Joint J 2013; 95-B: 1348-1353
  CrossrefPubMedGoogle Scholar