Gibt es die ideale Knietotalendoprothese für jüngere Patienten?

Zusammenfassung

Hintergrund: Bisherige Knieendoprothesensysteme sind nicht in der Lage, die komplexe Kinematik des Kniegelenks adäquat zu rekonstruieren. Da neue Prothesensysteme diese biomechanischen Anforderungen berücksichtigen, sollte die Hypothese geprüft werden, dass mit dem neuen ATTUNE™-Prothesensystem (DePuy, Warsaw, IN, USA) bei jüngeren Patienten eine messbar bessere Funktion bereits frühpostoperativ nachweisbar ist.
Material und Methoden: In diese prospektive Studie wurden 55 konsekutive Patienten < 70 Jahre mit Implantation einer ATTUNE™-Knieendoprothese (01/2012 bis 07/2012) bei primärer Gonarthrose eingeschlossen. Alle Patienten wurden von 1Operateur kreuzbanderhaltend unter Verwendung einer rotierenden Plattform versorgt. Präoperativ und 6 Monate postoperativ wurden die Beweglichkeit des Kniegelenks und die mediolaterale/sagittale Stabilität (Knee-Society-Score) miteinander verglichen.
Ergebnisse: Alle 55 Patienten waren für die Nachuntersuchung verfügbar. Das mittlere Patientenalter betrug 63 ± 8 Jahre. Die Geschlechtsverteilung zeigte 30 weibliche (54 %) und 25 männliche (46 %) Patienten. Das durchschnittliche Bewegungsausmaß verbesserte sich von 112,33 ± 13,6° auf 123,60 ± 11,1° (p < 0,001). Die mediolaterale Kniegelenkstabilität konnte signifikant verbessert werden (p < 0,001), während die sagittale Stabilität erhalten blieb (p > 0,05).
Schlussfolgerung: Wir konnten im Vergleich zur Literatur verbesserte frühfunktionelle Ergebnisse mit einem modernen Knieprothesensystem bei jüngeren Patienten erreichen. Auch wenn sicher noch keine Prothese als ideal zu bezeichnen ist, erscheint durch die Berücksichtigung der biomechanischen Erkenntnisse im Prothesendesign das Erreichen besserer Ergebnisse in der Knieendoprothetik möglich.

Abstract

Background: A total knee arthroplasty (TKA) is still not able to reinstate the physiological kinematics of the knee. This results in a considerable number of unsatisfied patients, especially if they are younger and active. Recently developed TKA systems claim to consider these biomechanical properties. The current study investigates the outcome (range of motion, stability) of the new ATTUNE™ TKA system (DePuy, Warsaw, IN, USA) in in young patients.
Material and Methods: This was a prospective study design (55 patients, 55 knees, age < 70 years, 01/2012–07/2012). Patients received an ATTUNE™ TKA and were examined preoperatively and at 6 months postoperatively for range of motion and stability (Knee Society score).
Results: Age: 63 ± 8 years; range of motion increased from 112.33 ± 13.6° to 123.60 ± 11,1° (p < 0.001). Coronal stability improved significantly (preoperatively vs. postoperatively, p < 0.001). Sagittal stability was not significantly different (preoperatively vs. postoperatively, p > 0.05).
Conclusion: The data of this study show improved early functional results in younger patients in comparison to the current literature. However, until now no existing TKA system can be identified as ideal. But taking recent biomechanical knowledge into consideration, modern TKA designs have the potential to improve the functional outcome. Especially for younger patients with superior muscle-status and coordinative abilities this seems beneficial.

Schlüsselwörter

Knieendoprothese - jüngerer Patient - Beweglichkeit - Stabilität

Key words

total knee arthroplasty - younger patient - range of motion - stability

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