Ist die unikondyläre Knieprothese eine zeitgemäße Möglichkeit der Primärversorgung bei Varusgonarthrose? - Eine prospektive matched-pair-Studie

Zusammenfassung.

Studienziel: In der vorliegenden Studie wurde eine Follow-up-Untersuchung der mittelfristigen Ergebnisse nach unikondylären und bikondylären Knie-TEP mittels matched-pair-Vergleich durchgeführt. Material und Methoden: Dabei wurden zwei Gruppen mit jeweils 18 Patienten nachuntersucht. In der ersten der beiden Gruppen waren Patienten mit einer unikondylären Schlittenprothese vom Typ Wessinghage, in der zweiten Patienten mit zementfreiem Oberflächenersatz vom Typ Natural knee. Die durchschnittliche Follow-up-Zeit betrug 4,5 Jahre (SD ± 0,6). Das Durchschnittsalter der Patienten beider Gruppen lag bei 59 Jahren (SD ± 3). In beiden Gruppen waren je 12 weibliche und 6 männliche Patienten. Alle Patienten litten unter primärer Varusgonarthrose. In allen Fällen wies auch die Gegenseite Zeichen einer manifesten Gonarthrose auf. Die Erfassung und Bewertung der Ergebnisse erfolgte nach dem Score der Amerikanischen Knee-Society. Zusätzlich erfolgte eine radiologische Befundung mit Beurteilung des Prothesensitzes, der Lysesäume und der Patellaposition. Ergebnisse: Der mittlere Knie-Score zeigte keine signifikanten Unterschiede bei Patienten mit zementfreiem Oberflächenersatz und Patienten mit unikondylären Schlittenprothesen. In der Tendenz wiesen Patienten mit Schlittenprothese sogar bessere Ergebnisse auf. Die durchschnittlichen Ergebnisse des Knie-Scores waren 94,3 (SD ± 4,9) in der Wessinghage-Gruppe und 91,9 (SD ± 8,3) in der Natural-Knee-Gruppe. In der Gruppe mit Oberflächenersatz wurden bei der radiologischen Auswertung keine Lysesäume gefunden, in der Gruppe mit unikondylärem Ersatz fanden wir in 7 Fällen Lysesäume von 1 mm oder mehr im Bereich des Tibiateils. In keinem dieser Fälle jedoch traten klinische Symptome auf. Schlussfolgerung: Unsere Ergebnisse zeigen, dass die Implantation unikondylärer medialer Schlittenprothesen eine effektive Methode zur Versorgung bei primärer Varusgonarthrose darstellt, auch in Hinsicht auf eventuelle Wechseloperationen.

Aim: In the present study, we performed a follow-up investigation comparing middle-term results after unicompartmental and bicompartmental knee arthroplasties. Material and Methods: We used matched pairs with 18 patients in each group. The first group was treated with the unicompartmental slegde prosthesis (Type Wessinghage), the second with the cementless nonconstrained bicondylar prosthesis (Type Natural knee). The mean time of follow-up was 4.5 years. (SD ± 0.6). The average age of the patients in both groups was 59 years (SD ± 3). Both groups included 12 female and 8 male patients. All patients suffered from primary medial osteoarthritis of the knee. In all cases, the contralateral knee also had signs of manifest osteoarthritis. The determination and evaluation of the results of the investigation were made according to the score of the American Knee Society. We also reviewed the radiological findings concerning placement of the prosthesis, radiolucent lines, and patella position in the femoral shield. Results: At follow-up examination, there were no significant differences in the knee score between the patients undergoing unicompartmental or total knee replacement. However, patients with the Wessinghage sledge tended to show better results. The mean knee score was 94.3 ± 4.9 in the Wessinghage group and 91.9 ± 8.3 in the Natural knee group. Evaluation of the radiographs revealed radiolucent lines in the group with total replacement. In contrast, in 7 of 18 patients with the unicompartmental prostheses we found radiolucent lines at the tibial component of 1 mm or more, which, however, did not cause clinical symptoms. Conclusion: Our results show, that the unicompartmental arthroplasty is still an effective method for the treatment of the osteoarthritis, especially concerning the conditions for possibly needed revisions.

Schlüsselwörter:

unikondyläre Schlittenprothese - zementfreier Oberflächenersatz - matched-pair-Studie - klinische Ergebnisse - radiologische Befunde

Key words:

sledge knee prosthesis - total knee replacement - matched pair study - clinical results - radiological findings

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