Navigation und Robotik in der Totalendoprothetik des Kniegelenks – Evidenz?

Die Integration von Navigationssystemen und Robotik in die Totalendoprothetik des Kniegelenks markiert einen Meilenstein in der orthopädischen Chirurgie. Durch präzise Planung und millimetergenaue Umsetzung eröffnet diese Fusion aus High-Tech und Heilkunst neue Dimensionen für eine individuell angepasste und effektive Kniegelenkrekonstruktion. Diese Artikel stellt die Entwicklung, den aktuellen Stand und die Evidenz von Navigation und Robotik in der Knietotalendoprothetik dar.

Kernaussagen

• Die computergestützte Navigation in der Knieendoprothetik erfolgt überwiegend bildfrei, d. h. es werden intraoperativ die notwendigen Landmarken in Relation zu am Knochen verankerten Trackern erfasst.

• Unterschiedliche Technologien werden als „robotergestützt“ bezeichnet. Alle robotischen Systeme beruhen auf einer Navigation. Es existieren sowohl bildfreie als auch bildgestützte Systeme. Die robotischen Tätigkeiten reichen von einer reinen Positionierung konventioneller Schnittblöcke bis hin zu haptisch kontrollierten Sägen an einem Roboterarm.

• Mittels computerassistierter Navigation sowie mit roboterassistierten Systemen konnte die Präzision der Implantation von Knietotalendoprothesen verbessert werden. Dadurch konnte bisher ein geringer Effekt hinsichtlich der Reduktion von Revisionsraten erreicht werden.

• Das von den Patienten berichtete Outcome konnte durch die Nutzung von Navigation und Robotik bisher nicht relevant verbessert werden.

• In Bezug auf eine Verbesserung des patientenberichteten Outcomes scheinen die technologischen Unterstützungen vor allem dann hilfreich zu sein, wenn sie für individualisierte Alignment-Strategien genutzt werden. Es zeigt sich eine zunehmende Evidenz, dass dies wichtiger ist als die reine Unterstützung der Knochenschnitte für ein mechanisches Alignment.

Schlüsselwörter

Knie-TEP - roboterassoziierte Chirurgie - computergestützte Navigation - robotisches Operationssystem - Alignment

Publication History

Article published online:
27 March 2024

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