Zusammenfassung
Das Komplikationsspektrum nach Knieendoprothesenversorgung wurde nach 321 Implantationen prospektiv analysiert. 53 (16,5 %) Patienten zeigten einen von der Routine abweichenden postoperativen Verlauf. Dabei erlitten 5,0 % der Patienten klinisch manifeste tiefe Beinvenenthrombosen, 1,6 % Protheseninfektionen, 3,7 % persistierende oder rezidivierende Gelenkergussbildungen, 4,4 % Arthrofibrosen und 1,9 % Wundheilungsstörungen. Zur Behandlung tiefer Infektionen wurde überwiegend ein zweizeitiger Prothesenwechsel durchgeführt. Arthrofibrosen wurden primär mittels manueller Mobilisierung in Narkose behandelt. Die Therapie rezidivierender Gelenkergüsse bestand aus - in einigen Fällen wiederholten - Gelenkpunktionen. Bei einem Patienten war die Einlage einer Drainage erforderlich. Patienten mit Wundheilungsstörungen wurden in Abhängigkeit vom Befund mit konservativer Lokaltherapie behandelt oder revidiert. Bei Unterschenkelvenenthrombosen setzten wir die Standard-Heparinisierung fort. Patienten mit der Diagnose einer Oberschenkelvenenthrombose wurden marcumarisiert.
Abstract
Complications after total knee arthroplasty were evaluated prospectively after a total of 321 procedures. 53 (16.5 %) patients showed postoperative courses deviating from the routine. Of these 5.0 % developed clinically relevant deep vein thromboses, the rate of deep infections was 1.6 %, 3.7 % of the patients suffered from persisting or recurrent joint effusions, arthrofibrosis was observed in 4.4 % of the patients and 1.9 % were affected by wound complications. In most patients deep infections were treated by removal of the implants and reimplantation after clearing of the infection. The primary treatment of arthrofibrosis consisted of manipulation under general or regional anaesthesia. Patients with recurrent joint effusions received punctions, which had to be repeated in some cases. In one patient an intraarticular drainage had to be inserted. The conservative or surgical therapy of wound complications depended on the patient’s situation. In patients with thrombosis distal to the trifurcation of the popliteal vein anticoagulation with heparin was continued. In contrast, in patients with femoral or popliteal venous thrombosis the anticoagulation was changed to cumarine derivates.
Schlüsselwörter
Knieendoprothese - Infektion - Arthrofibrose - Thrombose - Gelenkerguss
Key words
Total knee arthroplasty - infection - arthrofibrosis - thrombosis - joint effusion
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PD Dr. med. Reinhard Steffen
Marienkrankenhaus
An St. Swidbert 17
40489 Düsseldorf
