Vergleich funktioneller Ergebnisse zwischen medialem parapatellarem und Midvastus-Zugang in der Knieendoprothetik

Zusammenfassung

Für die Implantation von Knietotalendoprothesen kommen verschiedene operative Zugänge zur Anwendung. Klinische Analysen belegen, dass insbesondere dem Midvastus-Zugang (MV) in der frühen Rehabilitationsphase ein Vorteil gegenüber dem medialen parapatellaren Zugang (MPP) zugeschrieben wird. Ziel dieser Arbeit war es, herauszufinden, ob der klinische sich auch in einem funktionellen Vorteil des MV äußert. Die prospektiv-randomisierte Studie wurde einfach verblindet basierend auf eine Poweranalyse angelegt. Zufällig einer Gruppe zugeordnete Patienten (MPP = 10, MV = 11) wurden mittels instrumenteller Ganganalyse (VICON) vor, 5 Wochen (5 W) und 6 Monate (6 M) nach der Operation untersucht. Die Ergebnisse wurden einer gesunden Vergleichsgruppe (VG = 53) gegenübergestellt. Der primäre Zielpunkt war neben klinischen Parametern die Analyse objektiver Gangparameter, der sekundäre die subjektive Selbsteinschätzung in Form klinischer Scores (Knee Society Score, WOMAC). Im postoperativen Untersuchungszeitraum verbesserten sich die Messwerte der Ganganalyseparameter in beiden Gruppen, ohne das Niveau der VG zu erreichen. Vorteile für die MV-Gruppe zeigten sich in den kinetischen Parametern sagittales Kniemoment (5 W) und Kniepower (5 W, 6 M). Ebenfalls in MV fand sich eine bessere subjektive Selbsteinschätzung (WOMAC, 6 M). In den klinischen Parametern unterschieden sich MV- und MPP-Zugang nicht. Zusammenfassend ist festzustellen, dass die MV- gegenüber der MPP-Gruppe in der frühen postoperativen Phase funktionell im Vorteil war und dieses durch das subjektive Allgemeinbefinden bestätigt wurde. Aus biomechanischer Sicht ist der MV-Zugang deshalb zu bevorzugen.

Abstract

There are various approaches for total knee arthroplasty (TKA). On the basis of an analysis of the clinical results, it has been demonstrated that the midvastus approach (MV) is advantageous in the early postoperative period compared to the medial parapatellar surgical approach (MPP). The aim of this investigation was therefore to investigate whether the clinical advantage of MV is reflected in the functional outcome. This single blinded, prospective, randomised study was based on a power analysis. Selected randomised patients (MPP = 10, MV = 11) were examined using an instrumental gait analysis system (VICON) preoperatively, and 5 weeks (5 W) and 6 months (6 M) after implantation. The results were compared to a healthy control group (CG = 53). Besides clinical parameters, the primary objective of this study was to measure objective gait parameters; the secondary objective was to record self-assessment (Knee Society score, WOMAC). In both treatment groups, the measurements improved during the investigation period, although most parameters did not reach the CG levels. MV gave better values for the kinetic parameters sagittal knee moment (5 W) and knee power (5 W, 6 M), as well as self-assessment (WOMAC, 6 M). Other clinical parameters were similar in the two groups. In summary, in the early postoperative period, MV led to advantages in function and in subjective behaviour in daily life. From the biomechanical point of view, the MV approach is preferable.

Schlüsselwörter

Knietotalendoprothese - operativer Zugang - Ganganalyse

Key words

total knee arthroplasty - surgical approach - gait analysis

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