Download PDF
Z Orthop Ihre Grenzgeb 2005; 143(5): 573-580
DOI: 10.1055/s-2005-836833
Kniegelenk

© Georg Thieme Verlag Stuttgart · New York

Minimalinvasiv implantierte unikondyläre Knieendoprothese Typ Stryker-Osteonics mit metal-backed Tibiakomponente: Ein 5-Jahres-Follow-up

Minimally Invasive Stryker-Osteonics Unicompartmental Knee Prosthesis with Metal-Backed Tibia Component: A 5-Year Follow-upS. Endres1 , 2 , E. Steinheiser3 , A. Wilke1 , 2
  • 1Klinik für Orthopädie und Rheumatologie der Philipps-Universität Marburg
  • 2Labor für experimentelle Orthopädie der Philipps-Universität Marburg
  • 3Städtisches Krankenhaus Nettetal - Zentrum für Arthroskopie und Endoprothetik
Further Information

Publication History

Publication Date:
11 October 2005 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Einleitung: Ziel der vorliegenden Arbeit war die Untersuchung der mittelfristigen Ergebnisse einer zementierten medialen, unikondylären Knieendoprothese mit metal-backed Tibiakomponente, implantiert in minimalinvasiver Operationstechnik. Methodik: Im Zeitraum zwischen 1997 und 1999 wurden einundneunzig mediale Knieendoprothesen vom Typ Stryker-Osteonics mit metal-backed Tibiakomponente in minimalinvasiver Technik in 91 Patienten implantiert. Präoperativ, 6 Wochen postoperativ, 1 Jahr, 3 Jahre und 5 Jahre postoperativ wurden die Patienten nach dem klinischen Kniebewertungsbogen nach Punkten (Knee-Society-Score nach Insall und Scott) untersucht. Es handelte sich um einen international anerkannten Bewertungsbogen, wobei zwischen einem klinischen Score und einem funktionellen Score unterschieden wurde (Maximalpunktzahl 100). Ergebnisse: Präoperativ betrug der durchschnittliche klinische Score 57,6 (44-66) und der funktionelle Score 63,3 (48-71). Im vorliegenden Untersuchungszeitraum kam es zu einer kontinuierlichen Verbesserung des Knee-Society-Score bei allen Patienten. Im Durchschnitt betrug bereits 1 Jahr später der klinische und funktionelle Score 94,8 (39-100) bzw. 93,6 (75-100) (p < 0,001). 5 Jahre nach Operation konnten lediglich noch 64 Patienten nachuntersucht werden, aber auch hier entsprach der Score dem der 3-Jahres-Nachuntersuchung (Knee-Score: 98,2/94-100; Function-Score: 98,9/85-100). Bei 3 Revisionsoperationen handelte es sich um eine Wechseloperation in einen zementierten, bikondylären Oberflächenersatz infolge einer Prothesenlockerung. Diskussion: Die mediale, unikondyläre Knieendoprothese vom Typ Stryker-Osteonics mit metal-backed Tibiakomponente war bei guter Indikationsstellung eine alternative Therapiemöglichkeit der medialen Gonarthrose mit ausgezeichneten klinischen Ergebnissen dar. Durch die minimalinvasive Operationstechnik wurden vergleichbar gute Ergebnisse erzielt, die den Angaben in der Literatur bezüglich der konventionellen Methode entsprechen. Zusätzlich wurde vermutlich die Rehabilitationszeit verkürzt und die Weichteiltraumatisierung vermindert.

Abstract

Introduction: The aim of this study was to evaluate the medium-term results of minimally invasive unicompartmental knee joint arthroplasty with a metal-backed tibia component. Material and Methods: Ninety-one unicompartmental knee replacements with a metal-backed tibia component, type SCR-Stryker Osteonics, were implanted in a minimally invasive technique in 91 patients between 1997 and 1999. The evaluation of medium-term results was based on The Knee Society Clinical Rating System by Insall and Scott and was done at 6 weeks, 1, 3 and 5 years after surgery. This rating system is based on the clinical and symptoms of the patient (maximum score 100). Results: Preoperatively, the average knee score was 57.6 (44-66), the function score 63.3 (48-71). Throughout the period of investigation all patients had an increased knee and function score. One year after surgery the knee and function scores increased to 94.8 (39-100) and 93.6 (75-100). Five years post-implantation only 64 patients could be re-evaluated but they also had a knee and function score corresponding to the 3-year results [knee score: 98.2 (94-100); function score: 98.9 (85-100)]. Revision surgery using a total knee prosthesis was performed in 3 cases. Discussion: The unicompartmental knee arthroplasty was a good surgical method for managing medial, unicompartmental arthritis of the knee joint. The results presented by the authors and corroborated by many literature data provide evidence that unicompartmental arthroplasty is of great importance in the treatment of unicompartmental knee arthritis. The results achieved by the minimally invasive technique of a unicompartmental knee arthroplasty with a metal-backed tibia component of the type Stryker-Osteonics were equal to the conventional surgical technique in literature. Good indications were patients older than 60 years with normal weight and normal sports activity. Well-functioning collateral and cruciate ligaments were mandatory. Moreover, the minimally invasive technique may lead to a shorter time of rehabilitation because of the reduced soft tissue damage.

Schlüsselwörter

minimalinvasiv - metal-backed - unikondyläre Knieendoprothese

Key words

Unicompartmental knee arthroplasty - minimally invasive technique - metal-backed tibia component

Literatur

  • 1 Bartel D L, Bicknell V L, Wright T M. The effect of conformity, thickness, and material on stresses in ultra-high molecular weight components for total joint replacement.  J Bone Joint Surg [Am]. 1986;  68 1041-1051
    PubMedSearch in Google Scholar
  • 2 Bengtson S, Knutson K. The infected knee arthroplasty. A 6-year follow-up of 357 cases.  Acta Orthop Scand. 1991;  62 301-311
    CrossrefPubMedSearch in Google Scholar
  • 3 Berger R A, Nedeff D D, Barden R M, Sheinkop M M, Jacobs J J, Resenberg A G, Galante J O. Unicompartmental knee arthroplasty. Clinical experience at 6- to 10-year follow-up.  Clin Orthop Relat Res. 1999;  367 50-60
    PubMedSearch in Google Scholar
  • 4 Bottner F, Pavone V, Johnson T, Heitkemper S, Sculco T P. Blood management after bilateral total knee arthroplasty.  Clin Orthop Relat Res. 2003;  410 254-261
    PubMedSearch in Google Scholar
  • 5 Choi H R, Hasegawa Y, Kondo S, Shimizu T, Ida K, Iwata H. High tibial osteotomy for varus gonarthrosis: a 10- to 24-year follow-up study.  J Orthop Sci. 2001;  6 493-497
    CrossrefPubMedSearch in Google Scholar
  • 6 Deshmukh R V, Scott R D. Unicompartmental knee arthroplasty for younger patients: an alternative view.  Clin Orthop. 2002;  404 108-112
    PubMedSearch in Google Scholar
  • 7 Deshmukh R V, Scott R D. Unicompartmental knee arthroplasty: long-term results.  Clin Orthop. 2001;  392 272-278
    PubMedSearch in Google Scholar
  • 8 Engh G A, Ammeen D. Is an intact anterior cruciate ligament needed in order to have a well-functioning unicondylar knee replacement?.  Clin Orthop Relat Res. 2004;  428 170-173
    PubMedSearch in Google Scholar
  • 9 Engh G A, Dwyer K A, Hanes C K. Polyethylene wear of metal-backed tibial components in total and unicompartmental knee prostheses.  J Bone Joint Surg [Br]. 1992;  74 9-17
    PubMedSearch in Google Scholar
  • 10 Engh G A, McAuley J P. Unicondylar arthoplasty: An option for high-demand patients with gonarthrosis.  Instr Course Lect. 1999;  48 143-148
    PubMedSearch in Google Scholar
  • 11 Hauselmann H J, Muff L, Stucki G. Gonarthrosis - assessment and conservative therapy.  Ther Umsch. 1996;  53 732-737
    PubMedSearch in Google Scholar
  • 12 Hyldahl H C, Regner L, Carlsson L, Karrholm J, Weidenhielm L. Does metal backing improve fixation of tibial component in unicondylar knee arthroplasty? A randomized radiostereometric analysis.  J Arthroplasty. 2001;  16 174-179
    CrossrefPubMedSearch in Google Scholar
  • 13 Insall J N, Dorr L D, Scott R D, Scott W N. Rationale of the Knee Society clinical rating system.  Clin Orthop. 1989;  248 13-14
    PubMedSearch in Google Scholar
  • 14 Jefferson R J, Whittle M W. Functional biomechanical results of unicompartmental knee arthroplasty compared with total condylar arthroplasty and tibial osteotomy.  J Bone Joint Surg [Br]. 1990;  72 161-162
    PubMedSearch in Google Scholar
  • 15 Jenny J Y, Boeri C. Accuracy of implantation of a unicompartmental total knee arthroplasty with 2 different instrumentations: a case-controlled comparative study.  J Arthroplasty. 2002;  17 1016-1020
    CrossrefPubMedSearch in Google Scholar
  • 16 Kozinn S C, Scott R. Unicondylar knee arthroplasty.  J Bone Joint Surg [Am]. 1989;  71 145-149
    PubMedSearch in Google Scholar
  • 17 Labek G, Bohler N. Minimally invasive medial unicompartmental knee replacement.  Der Orthopäde. 2003;  32 454-460
    PubMedSearch in Google Scholar
  • 18 Lai C H, Rand J A. Revision of failed unicompartmental total knee arthroplasty. Clin Orthop Relat Res 1993; 193-201
  • 19 Levine W N, Ozuna R M, Scott R D. Conversion of failed modern unicompartmental arthroplasty to total knee arthroplasty.  J Arthroplasty. 1996;  11 797-801
    CrossrefPubMedSearch in Google Scholar
  • 20 Lindstrand A, Stenstrom A, Ryd L, Toksvig-Larsen S. The introduction period of unicompartmental knee arthroplasty is critical: a clinical, clinical multicentered, and radiostereometric study of 251 Duracon unicompartmental knee arthroplasties.  J Arthroplasty. 2000;  15 608-616
    CrossrefPubMedSearch in Google Scholar
  • 21 McAuley J P, Engh G A, Ammeen D J. Revision of failed unicompartmental knee arthroplasty.  Clin Orthop. 2001;  392 279-282
    PubMedSearch in Google Scholar
  • 22 Murray D W, Goodfellow J W, O'Connor J J. The Oxford medial unicompartmental arthroplasty: a ten-year survival study.  J Bone Joint Surg [Br]. 1998;  80 983-989
    PubMedSearch in Google Scholar
  • 23 Newman J H, Ackroyd C E, Shah N A. Unicompartmental or total knee replacement? Five-year results of a prospective randomized trial of 102 osteoarthritic knees with unicompartmental arthritis.  J Bone Joint Surg [Br]. 1998;  80 862-865
    PubMedSearch in Google Scholar
  • 24 Newman J H. Unicompartmental knee replacement.  Knee. 2000;  7 63-70
    CrossrefPubMedSearch in Google Scholar
  • 25 Price A J, Webb J, Topf H, Dodd C A, Goodfellow J W, Murray D W. Oxford Hip and Knee Group . Rapid recovery after oxford unicompartmental arthroplasty through a short incision.  J Arthroplasty. 2001;  16 970-976
    CrossrefPubMedSearch in Google Scholar
  • 26 Rajasekhar C, Das S, Smith A. Unicompartmental knee arthroplasty. 2- to 12-year results in a community hospital.  J Bone Joint Surg [Br]. 2004;  86 983-985
    PubMedSearch in Google Scholar
  • 27 Repicci J A, Eberle R W. Minimally invasive surgical technique for unicondylar knee arthroplasty.  J South Orthop Assoc. 1999;  8 20-27
    PubMedSearch in Google Scholar
  • 28 Ridgeway S R, McAuley J P, Ammeen D J, Engh G A. The effect of alignment of the knee on the outcome of unicompartmental knee replacement.  J Bone Joint Surg [Br]. 2002;  84 351-355
    PubMedSearch in Google Scholar
  • 29 Robertsson O, Borgquist L, Knutson K, Lewold S, Lidgren L. Use of unicompartmental instead of tricompartmental prostheses for unicompartmental arthrosis in the knee is a cost-effective alternative. 15 437 primary tricompartmental prostheses were compared with 10 624 primary medial or lateral unicompartmental prostheses.  Acta Orthop Scand. 1999;  70 170-175
    PubMedSearch in Google Scholar
  • 30 Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. 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
    CrossrefPubMedSearch in Google Scholar
  • 31 Rougraff B T, Heck D A, Gibson A E. A comparison of tricompartmental and unicompartmental arthroplasty for the treatment of gonarthrosis.  Clin Orthop. 1991;  273 157-164
    PubMedSearch in Google Scholar
  • 32 Svard U C, Price A J. Oxford medial unicompartmental knee arthroplasty. A survival analysis of an independent series.  J Bone Joint Surg [Br]. 2001;  83 191-194
    PubMedSearch in Google Scholar
  • 33 Tabor O B, Tabor O B. Unicompartmental arthroplasty: a long-term follow-up study.  J Arthroplasty.. 1998;  13 373-379
    CrossrefPubMedSearch in Google Scholar
  • 34 Yang K Y, Wang M C, Yeo S J, Lo N N. Minimally invasive unicondylar versus total condylar knee arthroplasty - early results of a matched-pair comparison.  Singapore Med J. 2003;  44 559-562
    PubMedSearch in Google Scholar

Dr. med. Stefan Endres

Universitätsklinikum der Philipps-Universität Marburg

Baldingerstraße

35033 Marburg

Deutschland

Phone: + 49/64 21/2 86 36 91

Email: endres@med.uni-marburg.de