Minimalinvasive Zugänge am Kniegelenk – evidenzbasierter Vorteil in der Knieendoprothetik?^[*]

Zusammenfassung

Im Rahmen der vorliegenden Übersichtsarbeit wird die Anwendung von minimalinvasiven Operationstechniken zur Implantation einer Knieendoprothese schrittweise nach Kriterien der evidenzbasierten Medizin bewertet. Dafür ist die Formulierung einer patientenrelevanten, beantwortbaren Frage wesentlich. Diese lautet z. B. in diesem Zusammenhang: „Haben Patienten mit fortgeschrittener Gonarthrose bei Nutzung eines minimalinvasiven Zugangs zur Implantation einer Knieendoprothese eine kürzere Rehabilitation als Patienten, bei denen der Standardzugang verwendet wurde?“ Die vorhandene Literatur wird nach Studienqualität und möglichen Verzerrungen geordnet und bewertet. Metaanalysen basierend auf klinischen Studien deuten zunächst auf eine positive Beantwortung hin. Unter dem Gesichtspunkt einer systematischen Weiterentwicklung von chirurgischen Verfahren ist der Stellenwert von minimalinvasiven Operationstechniken in der Routineversorgung noch nicht abschließend zu beurteilen: Die vermehrt berichteten Komplikationen bei Anwendung von minimalinvasiven Operationstechniken führen zu einer zurückhaltenden Bewertung: Ein genereller Vorteil ist nicht vorhanden. Weitere Studien zu Lernkurven, Patientenselektion und Patientenpräferenzen sind erforderlich, bevor der Stellenwert von minimalinvasiven Operationsverfahren in der Knieendoprothetik eingeordnet werden kann.

Abstract

The impact of minimally invasive surgical techniques for implantation of a total knee arthroplasty is evaluated according to evidence-based medicine criteria. The patient-relevant clinical question can be formulated as: Is the rehabilitation of osteoarthritis patients with minimally invasive implantation of total knee arthroplasty faster compared to those with the conventional approach. The available literature is sorted and critically appraised with regard to methodological quality and risk of bias. Following the results of the meta-analyses the clinical question can be positively answered. Following the aspect of a structured evolution for surgical techniques, the meaning of a minimally invasive technique for total knee arthroplasty cannot be answered finally. Under the impression of more frequent surgical complications, the rating of the procedure is conservative. A general advantage is not apparent. Further studies investigating surgical learning curves, proper patient selection and the selection of the patient for such techniques are required, before the final judgement on the use of this technique can be formed.

Schlüsselwörter

minimalinvasiv - Knieendoprothetik - evidenzbasierte Medizin - Übersichtsarbeit

Key words

minimally invasive surgery - total knee arthroplasty - evidence-based medicine - review

^* Nach einem Vortrag vom Sektionstag der Arbeitsgemeinschaft für Endoprothetik DKOU 2012.

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