AE-Beitrag: Unikondylärer Ersatz vs. Totalendoprothese bei medialer Gonarthrose

Zusammenfassung

Hintergrund Die isolierte mediale Gonarthrose ist eine Kniegelenkspathologie, die operativ sowohl den Einsatz eines unikondylären Oberflächenersatzes (Schlittenprothese) als auch die Implantation einer Totalendoprothese gestattet. Eine einheitliche Empfehlung, welches Verfahren bei dieser speziellen Indikation zu bevorzugen ist, fehlt jedoch.

Material und Methoden In der vorliegenden Übersichtsarbeit sollen anhand der vorhandenen Literatur beide Verfahren bez. des klinischen Ergebnisses, des Langzeitüberlebens und der Komplikationsrate verglichen werden.

Ergebnisse Bezüglich des klinischen Outcomes zeigen die meisten Studien eine Überlegenheit des unikondylären Oberflächenersatzes. Hier ist jedoch zu beachten, dass diese Patienten häufig auch präoperativ einen besseren Ausgangsbefund aufwiesen, das Maß an Verbesserung jedoch vergleichbar zur Totalendoprothese war. Betrachtet man das Survival, so zeigen Studien, Institutional Registries und landesweite Register eine klare Überlegenheit der Totalendoprothese in der Langzeithaltbarkeit. Als potenzieller Bias muss hier die höhere Revisionsfreudigkeit bei der Schlittenprothese beachtet werden. Bezüglich der Mortalitätsrate zeigt die Literatur eine Überlegenheit der Schlittenprothese. Die implantatspezifischen Komplikationen sind wiederum bei der Schlittenprothese höher.

Schlussfolgerung Zusammengefasst ist eine klare Empfehlung für eines der beiden Verfahren aufgrund der Literaturlage nicht möglich. Das tendenziell bessere klinische Outcome und die niedrige Mortalitätsrate sprechen für den unikodylären Oberflächenersatz, während beim Langzeitüberleben und den implantatbedingten Komplikationen die Totalendoprothese im Vorteil ist.

Abstract

Background In end-stage medial osteoarthritis, the surgeon can decide whether to use unicompartmental or total knee arthroplasty for operative treatment of the patient. Despite the available literature there is a lack of evidence to suggest if one procedure can be rated as being superior to the other. With increasing demand for knee arthroplasty, treatment with the highest expectation of success will be of particular interest. The purpose of this manuscript was to analyse and compare the available literature on unicompartmental vs. total knee arthroplasty for the treatment of medial osteoarthritis.

Material and Methods In this review of literature, the two procedures were compared regarding their clinical outcome, implant survival, and complication rates.

Results Regarding the clinical outcome the unicompartmental knee arthroplasty was shown to be superior over total knee arthroplasty. However, studies were mostly retrospective and groups were also different preoperatively. Patients treated with unicompartmental knee arthroplasty had better preoperative range of motion and function scores. Unicompartmental and total knee arthroplasty showed comparably increased functional scores. Taking the implant survival as parameter, institutional registries, multicenter studies and arthroplasty registries found total knee arthroplasties to have a significantly better long-term survival in comparison to unicompartmental knee arthroplasty. However, data might be biased by the lower threshold to revise unicompartmental knee arthroplasty due to expected simple revision and more subjective indications for revision. Looking at the complication rate, one has to differentiate between general and implant-specific complications. While the unicompartmental knee arthroplasty was shown to be advantageous in terms of general complications and mortality, it was also shown to be inferior in terms of implant-specific complications.

Conclusion The available literature does not show one procedure to be superior to the other. The trend to a better clinical outcome and a lower mortality rate is advantageous for unicompartmental knee arthroplasty, while the better long-term survival and a lower risk of implant-specific complications may make total knee arthroplasty preferable.

Schlüsselwörter

Schlittenprothese - Totalendoprothese - mediale Gonarthrose - klinisches Ergebnis - Überlebensrate

Key words

unicompartmental knee arthroplasty - total knee arthroplasty - isolated medial osteoarthritis - clinical outcome - survival

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