Umgang mit der Beugekontraktur in der primären Knieendoprothetik

Zusammenfassung

Gegenstand des Beitrags sind Ursachen, klinische Relevanz und operative Techniken in der Knieendoprothetik bei Vorliegen einer Beugekontraktur. Die Beugekontraktur ist eine häufige Deformität des arthrotischen Kniegelenks. Die verminderte Streckfähigkeit des Kniegelenks kann durch verschiedene Faktoren ausgelöst werden. Prinzipiell handelt es sich um ein Mismatch zwischen Beugespalt und Streckspalt. Mittlere und schwere Beugekontrakturen müssen durch zusätzliche chirurgische Techniken korrigiert werden. Hierzu gehören Weichteiltechniken mit dem Release kontrakter Strukturen, die Entfernung von Osteophyten und die zusätzliche Resektion am distalen Femur. Ziel dieser Techniken ist die volle Streckfähigkeit des Kniegelenks. Während der Rehabilitationsphase muss die Korrektur durch intensive detonisierende Physiotherapie gesichert werden. Eine verbleibende Beugekontraktur nach KTEP führt zu schlechten funktionellen Ergebnissen und persistierenden Schmerzen.

Abstract

Flexion contracture is a common deformity of the arthritic knee. The present publication describes causes, clinical relevance and surgical technique in the presence of flexion contractures in total knee arthroplasty. Flexion contracture can be attributed to different causes. Basically it is a mismatch between flexion and extension gaps. Moderate and severe deformities have to be corrected by additional surgical interventions. In most cases soft tissue techniques with release of contracted structures, the removal of osteophytes and additional distal femoral bone resection are necessary. The goal of these interventions is to achieve full extension of the knee. During rehabilitation attention has to be paid to maintain it with intensive physical therapy. A remaining flexion contracture is associated with inferior functional outcome and persistent pain.

• Literatur

• 1 Kurtz SM, Lau E, Ong K et al. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 2009; 467: 2606-2612
• 2 Callaghan JJ, Beckert MW, Hennessy DW et al. Durability of a cruciate-retaining TKA with modular tibial trays at 20 years. Clin Orthop Relat Res 2013; 471: 109-117
• 3 Robertsson O, Dunbar M, Pehrsson T et al. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand 2000; 71: 262-267
• 4 Ritter MA, Lutgring JD, Davis KE et al. The role of flexion contracture on outcomes in primary total knee arthroplasty. J Arthroplasty 2007; 22: 1092-1096
• 5 Sedrakyan A, Romero L, Graves S et al. Survivorship of hip and knee implants in pediatric and young adult populations: analysis of registry and published data. J Bone Joint Surg Am 2014; 96 (Suppl. 01) S73-S78
• 6 Scuderi GR, Kochhar T. Management of flexion contracture in total knee arthroplasty. J Arthroplasty 2007; 22 (4 Suppl. 1) S20-S24
• 7 Tanzer M, Miller J. The natural history of flexion contracture in total knee arthroplasty: a prospective study. Clin Orthop Relat Res 1989; 248: 129-134
• 8 Baldini A, Scuderi GR, Aglietti P et al. Flexion extension gap changes during total knee arthroplasty. Effect of posterior cruciate ligament and posterior osteophyte removal. J Knee Surg 2004; 17: 69-72
• 9 Laskin RS, Rieger M, Schob C et al. The posterior stabilized total knee prosthesis in the knee with severe fixed deformity. Am J Knee Surg 1988; 1: 199
• 10 Lombardi AV, Mallory TH. Dealing with Flexion Contractures in total Knee Arthroplasty. In: Insall JN, Scott WN, Scuderi GR, eds. Current Concepts in primary and Revision total Knee Arthroplasty. Philadelphia: Lippincott-Raven; 1996: 191
• 11 Tarabichi S, Tarabichi Y, Hawari M. Achieving deep flexion after primary total knee arthroplasty. J Arthroplasty 2010; 25: 219-224
• 12 Tarabichi S, Tarabichi Y. Can an anterior quadriceps release improve range of motion in the stiff arthritic knee?. J Arthroplasty 2010; 25: 571-575
• 13 Zaidi SH, Cobb AG, Bentley G. Danger to the popliteal artery in high tibial osteotomy. J Bone Joint Surg Br 1995; 77: 384-386
• 14 Bellemans J, Vandenneucker H, Victor J et al. Flexion contractures in total knee arthroplasty. Clin Orthop 2006; 452: 78
• 15 Berend KR, Lombardi AV, Adams JB. Total knee arthroplasty in patients with greater than 20 degrees flexion contracture. Clin Orthop 2006; 452: 83