Technik des Patellaersatzes bei defizientem Knochenlager

Zusammenfassung

Die Revision eines Patellaimplantats nach Knietotalendoprothese ist bei defekten Knochenlagern eine besondere chirurgische Herausforderung. Je nach Ausmaß des Knochendefekts werden unterschiedliche Rekonstruktionen mit Videos demonstriert: Video 1: Die knochenschonende Entfernung des Patellaimplantats: Onlay-Type-Patellaimplantat. Video 2: Knöcherner Rand erhalten, restliche Patelladicke 6–10 mm: Bikonvexe Patellaprothese. Video 3 und 4: Knochenrand weitgehend erhalten, restliche Patelladicke 1–5 mm: Gull-Wing-Osteotomie, Patella-Bone-Grafting-Technik. Video 5: Nekrosen mit partiellem Fehlen des knöchernen Randes und defektem Patellagrund: Porous-Tantalum-Patellaprothese. Nachdem für verschiedene Knochendefekte unterschiedliche rekonstruktive operative Verfahren zur Verfügung stehen, sollten die Patellektomie und die reine Patelloplastie möglichst vermieden werden, um funktionelle Defizite zu verhindern.

Abstract

The patella replacement in revision surgery is a challenge especially in cases of unsufficient bone stock. Depending on the extent of the bone defect, the following videos demonstrate different approaches: Video 1: bone sparing removal of the patella implant: onlay-type patella implants. Video 2: complete cortical bone rim of the patella, residual thickness between 6 to 10 mm: biconvex patella implant. Video 3 and 4: small defects of the cortical bone rim of the patella, residual thickness 1 to 5 mm (patella shell): gull-wing osteotomy, patella bone grafting techniques. Video 5: partial necrosis/defect of the patella shell with incomplete cortical bone rim: porous tantalum patella prosthesis. On account of the various surgical options for different bone defects of the patella, patellectomy and pure patelloplasty should be avoided to prevent functional shortcomings.

• Literatur

• 1 Kurtz S, Ong K, Lau E et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 894: 780-785
• 2 Garcia RM, Kraay MJ, Conroy-Smith PA et al. Management of the deficient patella in revision total knee arthroplasty. Clin Orthop Relat Res 2008; 466: 2790-2797
• 3 Maheshwer CB, Mitchell E, Kraay M et al. Revision of the patella with deficient bone using a biconvex component. Clin Orthop Relat Res 2005; 440: 126-130
• 4 Vince K, Roidis N, Blackburn D. Gull-wing sagittal patellar osteotomy in total knee arthroplasty. Techn Knee Surg 2002; 1: 106-112
• 5 Klein GR, Levine HB, Ambrose JF et al. Gull-wing osteotomy for the treatment of the deficient patella in revision total knee arthroplasty. J Arthroplasty 2010; 25: 249-253
• 6 Hanssen AD. Bone-grafting for severe patellar bone loss during revision knee arthroplasty. J Bone Joint Surg Am 2001; 83: 171-176
• 7 Ries MD, Cabalo A, Bozic KJ et al. Porous tantalum patellar augmentation: the importance of residual bone stock. Clin Orthop Relat Res 2006; 452: 166-170