Die Behandlung moderater Kniegelenksarthrosen durch arthroskopisches Gelenkdebridement

Zusammenfassung

Zielstellung: Diese Studie wurde mit dem Ziel durchgeführt, den Effekt des arthroskopischen Gelenkdebridements bei Gonarthrose Grad III nach Kellgren-Lawrence über einen 5-Jahres-Zeitraum zu untersuchen.

Material und Methode: Bei 96 Patienten (50 Männer und 46 Frauen) erfolgte ein arthroskopisches Gelenkdebridement. Einschlusskriterien waren eine symptomatische Gonarthrose Grad III und eine Beschwerdedauer von maximal 2 Jahren.

Ergebnisse: Gemessen am KOOS (Knee Injury and Osteoarthritis Outcome Score) profitierten die Patienten signifikant. Allerdings kommt drei Jahre postoperationem wieder zu einer Verschlechterung des Ergebnisses. Trotzdem sind die durchschnittlichen Punktwerte im KOOS auch noch nach 5 Jahren signifikant höher als zum Zeitpunkt der Eingangsuntersuchung. Bei 17,2 % (n = 17) der Patienten wurde innerhalb der Beobachtungszeitraumes eine endoprothetische Versorgung erforderlich. Die mittlere Zeit bis zur Endoprothesenkonversion von 56,6 (95 % KI 54,4 − 58,4) Monaten; p < 0,001.

Schlussfolgerungen: In moderaten Erkrankungsstadien der Gonarthrose kann ein arthroskopischer Eingriff effektiv die subjektiven Beschwerden reduzieren. Da jedoch der Arthroseprozess generell durch die Behandlungen nicht zu beeinflussen ist, verschlechtern sich über einen längeren Zeitraum die Ergebnisse wieder signifikant.

Abstract

Purpose: This study is aimed to compare the effects of arthroscopic joint debridement over a 5-year period in a clearly defined patient population (only grade III knee osteoarthritis, history < 2 years).

Material and Methods: A total of 96 patients (50 male and 46 female) underwent arthroscopic knee debridement for knee OA. The main criteria for inclusion were osteoarthritis grade III (Kellgren-Lawrence score) and a maximal history of 2 years.

Results: The subjective complaints and the knee-related quality of life were estimated by the KOOS (knee injury and osteoarthritis outcome score). The score increased significantly within the 1 to 3 rd year post operation. After this interval the mean points of the score declined. But after 5 years the KOOS was higher in comparison to the baseline dates. Patients who had undergone conservative treatment at baseline had a significantly different KOOS than patients in the arthroscopy group. Over time, patients in the arthroscopy group had fewer complaints than patients in the conservative treatment group. In both groups, the results decreased over time. A total of 17 patients (17.2 %) needed a conversion to total endoprothetic replacement. The mean time-interval between index operation and conversion was 56.6 (95 % CI 54.4 − 58.4) months.

Conclusions: In middle stages of knee OA, arthroscopic joint debridement can effectively reduce subjective complaints. Because this treatment does not stop the process of OA, the improvements decrease over time.

Schlüsselwörter

Arthroskopie - Knie - Gonarthrose - Debridements - Review - klinische Studie

Key words

Arthroscopy - knee - ostearthritis - debridement - review - clinical trial

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