Periprothetische Frakturen des Kniegelenks

Zusammenfassung

In Anbetracht der demografischen Entwicklung und bei steigenden Implantationszahlen von Endoprothesen sind periprothetische Frakturen ein zunehmendes Problem. Im Bereich des Kniegelenks treten die meisten dieser Frakturen postoperativ nach einem Zeitraum von 2–4 Jahren auf. Ursache können Traumata, implantationsspezifische Faktoren und Prothesenlockerungen sein. Neben weiteren Risikofaktoren sind vor allem Osteopenie und ein vermindertes Bewegungsausmaß der Prothese zu nennen. Frakturklassifikationen, welche in der Frakturbeschreibung auch eine Lockerung der Prothese mit einbeziehen, sind ein wichtiges Instrument für die Therapieplanung. An Therapieoptionen kommen neben dem konservativen Vorgehen vor allem die operative Frakturstabilisierung oder ein Prothesenwechsel infrage. Die Versorgungsmöglichkeiten periprothetischer Frakturen am Kniegelenk werden unter Berücksichtigung der verschiedenen Ausgangssituationen und mit dem Ziel, eine belastungsstabile Situation für eine frühe Mobilisation zu erreichen, diskutiert.

Abstract

Periprosthetic fractures are a challenging problem in view of the demographic development and the increasing number of implanted prostheses. Most of these fractures occur postoperatively after a period of two to four years after implantation of a total knee arthroplasty. They are usually caused by traumata, implantation-specific factors and loosening of the prosthesis. Beside further risk factors osteopenia and a reduced mobility of the prosthesis predispose to these fractures. Numerous classifications which also include a loosening of the prosthesis in the fracture discription are an important tool for planning the therapy. Beside the conservative treatment, the stabilization of the fracture or changing the prosthesis should be considered. The treatment options of periprosthetic fractures of the knee joint are discussed in view of different initial situations with the aim of achieving a load-stable situation.

Key words

periprothetische Fraktur - Knietotalendoprothese - Osteopenie - Frakturklassifikatio - Behandlungskonzepte

Key words

periprosthetic fracture - total knee arthroplasty - osteopenia - fracture classification - treatment options

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