Zusammenfassung
Studienziel: Bei der navigierten Implantation einer Knieendoprothese wird das Hüftgekenkszentrum (HGZ) durch kreisende Bewegung des Femurs bestimmt (Pivotieren). Es ist unklar wie groß der Fehler dieser funktionellen HGZ-Bestimmung in vivo ist. In der vorliegenden Arbeit sollte daher erstmals die Genauigkeit des Pivotierens untersucht werden. Methode: 25 Patienten wurden bei primärer Gonarthrose Knietotalendopropthesen (TC-PLUS Solution, PLUS Orthopedics) navigiert implantiert (PI Galileo, PLUS Orthopedics). Die Position des Femurteils und des HGZ wurde postoperativ computertomographisch bestimmt. Durch Vergleich mit den intraoperativ dokumentierten Daten wurde die Abweichung des HGZ in der Frontal- und Sagittalebene berechnet. Der Arthrosegrad des Hüftgelenks wurde nach Kellgren bestimmt. Ergebnisse: Der durchschnittliche Fehler betrug in der Frontalebene 1,0 ± 0,7°, in der Sagittalebene 2,5 ± 1,6° (p = 0,002) entsprechend einer durchschnittlichen Abweichung von 20 ± 10 mm. Es zeigte sich eine kontinuierliche, statistisch nicht-normale Verteilung ohne Ausreißer. Der Koxarthrosegrad korrelierte nicht mit der Genauigkeit des Pivotierens. Mit zunehmendem Bewegungsausmaß des Beines während des Pivotierens in der Frontal- und Sagittalebene wurde die Bestimmung des HGZ ungenauer. Schlussfolgerung: In der Summe ergibt sich ein empfehlenswerter Bereich zwischen 20 und 30° in der Sagittalebene und 30 und 40° in der Frontalebene. Eine Koxarthrose stellt keine Kontraindikation für eine funktionelle Bestimmung des HGZ dar.
Abstract
Aim: In navigated knee arthroplasty the hip centre is determined by rotary motion of the femur (pivoting). The accuracy of this functional hip centre determination in vivo is unclear. In the following paper the accuracy of pivoting in the determination of the hip centre was examined. Methods: Navigated (TC-PLUS, Solution, PLUS Orthopedics) total knee arthroplasty (PI Galileo, PLUS Orthopedics) was performed on 25 patients with primary arthritis of the knee joint. The position of the femoral component and the hip centre were postoperatively determined by computer tomography. Through comparison with the intraoperatively documented data, the deviation of the pivoted from the true hip centre in the frontal and sagittal planes was calculated. The degree of arthritis of the hip was determined on plain radiographs according to Kellgren. Results: The mean deviation was determined to 1.0 ± 0.7° in the frontal plane and 2.5 ± 1.6° in the sagittal plane (p = 0.002). This corresponds to a mean overall deviation of 20 ± 10 mm. The data were continuously, non-parametrically distributed without any outliers. A great range of motion (ROM) in the frontal as well as sagittal planes during pivoting resulted in a less accurate determination of the hip centre. There was no correlation to the degree of arthritis of the hip. Conclusion: The results indicate a recommendable ROM during pivoting for maximal accuracy of hip centre determination of 20 to 30° in the sagittal plane and 30 to 40° in the frontal plane. Arthritis of the hip is not a contraindication for functional determination of the hip centre.
Schlüsselwörter
Knietotalendoprothese - Navigation - Hüftgelenkzentrum - Pivotieren
Key words
total knee arthroplasty - navigation - hip centre - pivoting
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Dr. med. G. Matziolis
Centrum für Musculoskeletale Chirurgie · Charité - Universitätsmedizin Berlin
Schumannstr. 20-21
10117 Berlin
Phone: 0 30/4 50 61 50 93
Fax: 0 30/4 50 51 59 11
Email: Georg.Matziolis@Charite.de
