Zusammenfassung
Die Achskorrektur des Beines durch eine Umstellungsosteotomie sowie der endoprothetische Gelenkersatz sind heute bei der Behandlung der Gonarthrose nicht mehr wegzudenken. Das Ziel der valgisierenden Umstellungsosteotomie, die in zunehmendem Maße als medial-öffnende Osteotomie durchgeführt wird, ist es, die Tragelinie des Beines aus dem durch die Varusarthrose geschädigten Gelenkkompartiment in das nicht betroffene laterale Kompartiment zu verlagern. Von dieser Operation profitieren vor allem jüngere und aktive Patienten mit einer unikompartimentellen Arthrose. Durch verbesserte Implantationstechniken sind durch die Endoprothese exzellente oder gute Langzeitergebnisse möglich geworden. Methode der Wahl ist die Implantation der zumindest teilweise (tibial) zementierten Semiconstrained-Prothese. Die Standzeit der Prothese beträgt durchschnittlich 10 Jahre. Daneben kommt bei älteren und inaktiven Patienten die unikondyläre Prothesenimplantation bei auf ein Gelenkkompartiment beschränkten Arthrosen in Betracht.
Abstract
Axial realignment by osteotomy and arthroplasty are important methods in treatment of gonarthritis today. The osteotomies are purposed to transfer the mean bearing line of the leg from the destructed knee compartment into the non-affected area. The osteotomies are performed by the medial-opening techniques in a high frequency today. This operation is optimal in younger patients who suffering from unicompartimental gonarthritis. Arthroplasty also produces excellent or good long-term results, today. The implantation of semiconstrained cemented or partially cemented (tibial) bicondular endoprosthesis is method of choice in the mostly cases. The survival after arthroplasty amounts meanly 10 years. The unicondular joint replacement is only indicated in cases of unilateral gonarthritis in older and inactive patients.
Literatur
-
1
Aderinto J, Cobb A G.
Lateral release for patellofemoral arthritis.
Arthroscopy.
2002;
18
399-403
-
2
Aldinger P R, Gill H S, Schlegel U, Schneider M, Clauss M, Goodfellow J W, Murray D W, Breusch S J.
[Is computer navigation a useful tool in unicompartmental knee arthroplasty? A pilot cadaver study].
Orthopäde.
2005;
34
1096-1102
-
3
Anderson K C, Buehler K C, Markel D C.
Computer assisted navigation in total knee arthroplasty: comparison with conventional methods.
J Arthroplasty.
2005;
20
132-138
-
4
Ansari S, Newman J H, Ackroyd C E.
St. Georg sledge for medial compartment knee replacement. 461 arthroplasties followed for 4 (1 - 17) years.
Acta Orthop Scand.
1997;
68
430-434
-
5
Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifka J.
Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique.
J Bone Joint Surg [Br].
2004;
86
682-687
-
6
Berger R A, Nedeff D D, Barden R M, Sheinkop M M, Jacobs J J, Rosenberg 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
-
7
Berger R A, Rosenberg A G, Barden R M, Sheinkop M B, Jacobs J J, Galante J O.
Long-term follow-up of the Miller-Galante total knee replacement.
Clin Orthop Relat Res.
2001;
388
58-67
-
8
Bettin D, Karbowski A, Schwering L, Matthiass H H.
Time-dependent clinical and roentgenographical results of Coventry high tibial valgisation osteotomy.
Arch Orthop Trauma Surg.
1998;
117
53-57
-
9
Birke A, Reichel H, Hein W, Schietsch U, Hube R, Bernstein A, Kruger T.
[ROBODOC - a path into the future of hip endoprosthetics or an investment error?].
Z Orthop Ihre Grenzgeb.
2000;
138
395-401
-
10
Bolognesi M, Hofmann A.
Computer navigation versus standard instrumentation for TKA: a single-surgeon experience.
Clin Orthop Relat Res.
2005;
440
162-169
-
11
Borjesson M, Weidenhielm L, Mattsson E, Olsson E.
Gait and clinical measurements in patients with knee osteoarthritis after surgery: a prospective 5-year follow-up study.
Knee.
2005;
12
121-127
-
12
Borner M, Bauer A, Lahmer A.
[Computer-assisted robotics in hip endoprosthesis implantation].
Unfallchirurg.
1997;
100
640-645
-
13
Borner M, Bauer A, Lahmer A.
[Computer-guided robot-assisted hip endoprosthesis].
Orthopäde.
1997;
26
251-257
-
14
Buechel Sr F F, Buechel Jr F F, Pappas M J, D'Alessio J.
Twenty-year evaluation of meniscal bearing and rotating platform knee replacements.
Clin Orthop Relat Res.
2001;
388
41-50
-
15
Burnett R S, Haydon C M, Rorabeck C H, Bourne R B.
Patella resurfacing versus nonresurfacing in total knee arthroplasty: results of a randomized controlled clinical trial at a minimum of 10 years' follow-up.
Clin Orthop Relat Res.
2004;
428
12-25
-
16
Campbell D G, Duncan W W, Ashworth M, Mintz A, Stirling J, Wakefield L, Stevenson T M.
Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial.
J Bone Joint Surg [Br].
2006;
88
734-739
-
17
Capra Jr S W, Fehring T K.
Unicondylar arthroplasty. A survivorship analysis.
J Arthroplasty.
1992;
7
247-251
-
18
Cartier P, Sanouiller J L, Grelsamer R P.
Unicompartmental knee arthroplasty surgery. 10-year minimum follow-up period.
J Arthroplasty.
1996;
11
782-788
-
19
Chao E Y, Sim F H.
Computer-aided preoperative planning in knee osteotomy.
Iowa Orthop J.
1995;
15
4-18
-
20
Coventry M B.
Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report.
J Bone Joint Surg [Am].
1965;
47
984-990
-
21
Coventry M B.
Upper tibial osteotomy.
Clin Orthop Relat Res.
1984;
182
46-52
-
23
Coventry M B.
Proximal tibial osteotomy.
Orthop Rev.
1988;
17
456-458
-
24
Coventry M B, Ilstrup D M, Wallrichs S L.
Proximal tibial osteotomy. A critical long-term study of eighty-seven cases.
J Bone Joint Surg [Am].
1993;
75
196-201
-
25
Cullu E, Aydogdu S, Alparslan B, Sur H.
Tibial slope changes following dome-type high tibial osteotomy.
Knee Surg Sports Traumatol Arthrosc.
2005;
13
38-43
-
26
Dennis D A, Clayton M L, O'Donnell S, Mack R P, Stringer E A.
Posterior cruciate condylar total knee arthroplasty. Average 11-year follow-up evaluation.
Clin Orthop Relat Res.
1992;
281
168-176
-
27
Devgan A, Marya K M, Kundu Z S, Sangwan S S, Siwach R C.
Medial opening wedge high tibial osteotomy for osteoarthritis of knee: long-term results in 50 knees.
Med J Malaysia.
2003;
58
62-68
-
28
Dugdale T W, Noyes F R, Styer D.
Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length.
Clin Orthop Relat Res.
1992;
274
248-264
-
30
Esenkaya I, Elmali N.
Proximal tibia medial open-wedge osteotomy using plates with wedges: early results in 58 cases.
Knee Surg Sports Traumatol Arthrosc.
2006;
14
-
31
Fuchs S, Strosche H, Tinius W, Gierse H, Gebhardt U.
Preliminary remarks on a prospective multicenter study of the Repicci minimally invasive unicondylar knee replacement.
Knee Surg Sports Traumatol Arthrosc.
2005;
13
670-676
-
32
Georgoulis A D, Makris C A, Papageorgiou C D, Moebius U G, Xenakis T, Soucacos P N.
Nerve and vessel injuries during high tibial osteotomy combined with distal fibular osteotomy: a clinically relevant anatomic study.
Knee Surg Sports Traumatol Arthrosc.
1999;
7
15-19
-
33
Gill G S, Joshi A B.
Long-term results of Kinematic Condylar knee replacement. An analysis of 404 knees.
J Bone Joint Surg [Br].
2001;
83
355-358
-
34
Gill T, Schemitsch E H, Brick G W, Thornhill T S.
Revision total knee arthroplasty after failed unicompartmental knee arthroplasty or high tibial osteotomy.
Clin Orthop Relat Res.
1995;
321
10-18
-
35
Gleeson R E, Evans R, Ackroyd C E, Webb J, Newman J H.
Fixed or mobile bearing unicompartmental knee replacement? A comparative cohort study.
Knee.
2004;
11
379-384
-
36
Gluck T.
Erklärung.
Arch Klin Chir.
1891;
41
747
-
37
Gluck T.
Referat über die durch das moderne chirurgische Experiment gewonnenen positiven Resultate, betreffend die Naht und den Ersatz von Defecten höherer Gewebe sowie über die Verwertung resorbierbarer und lebendiger Tampons in der Chirurgie.
Arch Klin Chir.
1891;
41
187-239
-
38
Gunes T, Sen C, Erdem M.
Tibial slope and high tibial osteotomy using the circular external fixator.
Knee Surg Sports Traumatol Arthrosc.
2006;
14
-
39
Hansson U, Toksvig-Larsen S, Jorn L P, Ryd L.
Mobile vs. fixed meniscal bearing in total knee replacement: a randomised radiostereometric study.
Knee.
2005;
12
414-418
-
40 Heaton K T, Dorr L D. History of total knee arthroplasty. Callaghan JJ, Rosenberg AG, Rubash HE, Simonian PT, Wickiewicz TL The Adult Knee. Philadelphia, Baltimore, New York, London, Buenos Aires, Hong Kong, Sydney, Tokyo; Lippincott Williams and Wilkins 2003: 15-24
-
41
Heck D A, Marmor L, Gibson A, Rougraff B T.
Unicompartmental knee arthroplasty. A multicenter investigation with long-term follow-up evaluation.
Clin Orthop Relat Res.
1993;
286
154-159
-
42
Hernigou P, Ma W.
Open wedge tibial osteotomy with acrylic bone cement as bone substitute.
Knee.
2001;
8
103-110
-
43
Hernigou P, Medevielle D, Debeyre J, Goutallier D.
Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study.
J Bone Joint Surg [Am].
1987;
69
332-354
-
44
Jackson J P.
Osteotomy for osteoarthritis of the knee. Proceedings of the Sheffiled regional orthopaedic club.
J Bone Joint Surg [Br].
1958;
40
826
-
45 Jerosch J, Heisel (Hrsg) J. Knieendoprothetik. Indikationen, Operationstechnik, Nachbehandlung, Begutachtung. Berlin, Heidelberg, New York, Barcelona, Budapest, Hongkong, London, Mailand, Paris, Singapur, Tokio; Springer 1999
-
46
Katz M M, Hungerford D S, Krackow K A, Lennox D W.
Results of total knee arthroplasty after failed proximal tibial osteotomy for osteoarthritis.
J Bone Joint Surg [Am].
1987;
69
225-233
-
47
Kawano T, Miura H, Nagamine R, Urabe K, Matsuda S, Mawatari T, Moro-Oka T, Iwamoto Y.
Alignment in total knee arthroplasty following failed high tibial osteotomy.
J Knee Surg.
2003;
16
168-172
-
48 Keating E M, Meding J B. Implant fixation-cement. Callaghan JJ, Rosenberg AG, Rubash HE, Simonian PT, Wickiewicz TL The Adult Knee. Philadelphia, Baltimore, New York, London, Buenos Aires, Hong Kong, Sydney, Tokyo; Lippincott Williams and Wilkins 2003: 1067-1070
-
49
Kettelkamp D B, Leach R E, Nasca R.
Pitfalls of proximal tibial osteotomy.
Clin Orthop Relat Res.
1975;
106
232-241
-
50
Kim Y H, Sohn K S, Kim J S.
Range of motion of standard and high-flexion posterior stabilized total knee prostheses. A prospective, randomized study.
J Bone Joint Surg [Am].
2005;
87
1470-1475
-
51
Klinger H M, Lorenz F, Harer T.
Open wedge tibial osteotomy by hemicallotasis for medial compartment osteoarthritis.
Arch Orthop Trauma Surg.
2001;
121
245-247
-
52
Koshino T, Murase T, Takagi T, Saito T.
New bone formation around porous hydroxyapatite wedge implanted in opening wedge high tibial osteotomy in patients with osteoarthritis.
Biomaterials.
2001;
22
1579-1582
-
53
Lexer E.
Substitution of whole or half joints from freshly amputated extremities by free plastic operation.
Surg Gynecol Obstet.
1908;
6
601-607
-
54
Lobenhoffer P, Agneskirchner J, Zoch W.
[Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator].
Orthopäde.
2004;
33
153-160
-
55
Lobenhoffer P, Agneskirchner J D.
Improvements in surgical technique of valgus high tibial osteotomy.
Knee Surg Sports Traumatol Arthrosc.
2003;
11
132-138
-
56
Magyar G, Toksvig-Larsen S, Lindstrand A.
Open wedge tibial osteotomy by callus distraction in gonarthrosis. Operative technique and early results in 36 patients.
Acta Orthop Scand.
1998;
69
147-151
-
57
Maquet P.
Valgus osteotomy for osteoarthritis of the knee.
Clin Orthop Relat Res.
1976;
143-148
-
58
Marmor L.
Unicompartmental knee arthroplasty. Ten- to 13-year follow-up study.
Clin Orthop Relat Res.
1988;
226
14-20
-
59
Marti R K, Verhagen R A, Kerkhoffs G M, Moojen T M.
Proximal tibial varus osteotomy. Indications, technique, and five to twenty-one-year results.
J Bone Joint Surg [Am].
2001;
83
164-170
-
60
Matsuda S, Whiteside L A, White S E, McCarthy D S.
Knee stability in meniscal bearing total knee arthroplasty.
J Arthroplasty.
1999;
14
82-90
-
61
Matthews L S, Goldstein S A, Malvitz T A, Katz B P, Kaufer H.
Proximal tibial osteotomy. Factors that influence the duration of satisfactory function.
Clin Orthop Relat Res.
1988;
229
193-200
-
62
Merkow R L, Soudry M, Insall J N.
Patellar dislocation following total knee replacement.
J Bone Joint Surg [Am].
1985;
67
1321-1327
-
63
Mielke R K, Clemens U, Jens J H, Kershally S.
[Navigation in knee endoprosthesis implantation - preliminary experiences and prospective comparative study with conventional implantation technique].
Z Orthop Ihre Grenzgeb.
2001;
139
109-116
-
64
Mont M A, Antonaides S, Krackow K A, Hungerford D S.
Total knee arthroplasty after failed high tibial osteotomy. A comparison with a matched group.
Clin Orthop Relat Res.
1994;
299
125-130
-
65
Murphy S B.
Tibial osteotomy for genu varum. Indications, preoperative planning, and technique.
Orthop Clin North Am.
1994;
25
477-482
-
66
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
-
67
Myles C M, Rowe P J, Nutton R W, Burnett R.
The effect of patella resurfacing in total knee arthroplasty on functional range of movement measured by flexible electrogoniometry.
Clin Biomech (Bristol, Avon).
2006;
21
733-739
-
68
Odding E, Valkenburg H A, Algra D, Vandenouweland F A, Grobbee D E, Hofman A.
The association of abnormalities on physical examination of the hip and knee with locomotor disability in the Rotterdam Study.
Br J Rheumatol.
1996;
35
884-890
-
69
Odenbring S, Egund N, Knutson K, Lindstrand A, Larsen S T.
Revision after osteotomy for gonarthrosis. A 10 - 19-year follow-up of 314 cases.
Acta Orthop Scand.
1990;
61
128-130
-
70
Olanlokun K F, Wills D P.
A spatial model of the knee for the preoperative planning of knee surgery.
Proc Inst Mech Eng [H].
2002;
216
63-75
-
71
Pape D, Seil R, Adam F, Rupp S, Kohn D, Lobenhoffer P.
[Imaging and preoperative planning of osteotomy of tibial head osteotomy].
Orthopäde.
2004;
33
122-134
-
72
Parker D A, Rorabeck C H, Bourne R B.
Long-term follow-up of cementless versus hybrid fixation for total knee arthroplasty.
Clin Orthop Relat Res.
2001;
388
68-76
-
73
Post W R.
Anterior knee pain: diagnosis and treatment.
J Am Acad Orthop Surg.
2005;
13
534-543
-
74
Quaile A.
Measurement of the effects of lateral release.
J R Nav Med Serv.
1989;
75
159-163
-
75
Ranieri L, Traina G C, Maci C.
High tibial osteotomy in osteoarthrosis of the knee (a long term clinical study of 187 knees).
Ital J Orthop Traumatol.
1977;
3
289-300
-
76
Rees J L, Price A J, Lynskey T G, Svard U C, Dodd C A, Murray D W.
Medial unicompartmental arthroplasty after failed high tibial osteotomy.
J Bone Joint Surg [Br].
2001;
83
1034-1036
-
77
Ritter M A, Berend M E, Meding J B, Keating E M, Faris P M, Crites B M.
Long-term follow-up of anatomic graduated components posterior cruciate-retaining total knee replacement.
Clin Orthop Relat Res.
2001;
388
51-57
-
78
Rodner C M, Adams D J, az-Doran V, Tate J P, Santangelo S A, Mazzocca A D, Arciero R A.
Medial opening wedge tibial osteotomy and the sagittal plane: the effect of increasing tibial slope on tibiofemoral contact pressure.
Am J Sports Med.
2006;
34
1431-1441
-
79
Schai P A, Suh J T, Thornhill T S, Scott R D.
Unicompartmental knee arthroplasty in middle-aged patients: a 2- to 6-year follow-up evaluation.
J Arthroplasty.
1998;
13
365-372
-
80
Schai P A, Thornhill T S, Scott R D.
Total knee arthroplasty with the PFC system. Results at a minimum of ten years and survivorship analysis.
J Bone Joint Surg [Br].
1998;
80
850-858
-
81
Schlepckow P.
[Three dimensional kinematics of the knee joint].
Z Orthop Ihre Grenzgeb.
1990;
128
426-428
-
82
Schultz W, Gobel D.
Articular cartilage regeneration of the knee joint after proximal tibial valgus osteotomy: a prospective study of different intra- and extra-articular operative techniques.
Knee Surg Sports Traumatol Arthrosc.
1999;
7
29-36
-
83
Schultz W, Urbach D.
[Para-articular knee osteotomies].
Zentralbl Chir.
2000;
125
523-531
-
84
Scott R D, Cobb A G, McQueary F G, Thornhill T S.
Unicompartmental knee arthroplasty. Eight- to 12-year follow-up evaluation with survivorship analysis.
Clin Orthop Relat Res.
1991;
271
96-100
-
85
Sextro G S, Berry D J, Rand J A.
Total knee arthroplasty using cruciate-retaining kinematic condylar prosthesis.
Clin Orthop Relat Res.
2001;
388
33-40
-
86
Spahn G.
Mittelfristige Ergebnisse nach operativer Therapie bei habitueller oder rezidivierender Patellaluxation.
Akt Traumatol.
2001;
31
99-106
-
87
Spahn G, Wittig R.
Belastungsstabile Osteosynthese der opening-wedge Osteotomie des Tibiakopfes. Präliminarer Bericht und Literaturübersicht.
Akt Traumatol.
2002;
32
137-142
-
89
Spahn G.
Complications in high tibial (medial opening wedge) osteotomy.
Arch Orthop Trauma Surg.
2004;
124
649-653
-
91
Spahn G, Muckley T, Kahl E, Hofmann G O.
Biomechanical investigation of different internal fixations in medial opening-wedge high tibial osteotomy.
Clin Biomech (Bristol, Avon).
2006;
21
272-278
-
92
Spahn G, Wittig R.
Primary stability of various implants in tibial opening wedge osteotomy: a biomechanical study.
J Orthop Sci.
2002;
7
683-687
-
93
Squire M W, Callaghan J J, Goetz D D, Sullivan P M, Johnston R C.
Unicompartmental knee replacement. A minimum 15 year follow-up study.
Clin Orthop Relat Res.
1999;
61-72
-
94
Stoffel K, Stachowiak G, Kuster M.
Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate.
Clin Biomech (Bristol, Avon).
2004;
19
944-950
-
95
Stuart M J, Beachy A M, Grabowski J J, An K N, Kaufman K R.
Biomechanical evaluation of a proximal tibial opening-wedge osteotomy plate.
Am J Knee Surg.
1999;
12
148-153
-
96
Stukenborg-Colsman C, Wirth C J, Lazovic D, Wefer A.
High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 7 - 10-year follow-up prospective randomised study.
Knee.
2001;
8
187-194
-
97
Tabor Jr O B, Tabor O B.
Unicompartmental arthroplasty: a long-term follow-up study.
J Arthroplasty.
1998;
13
373-379
-
98
Takai S, Yoshino N, Hirasawa Y.
Revision total knee arthroplasty after failed high tibial osteotomy.
Bull Hosp Jt Dis.
1997;
56
245-250
-
99
Terry G C, Cimino P M.
Distal femoral osteotomy for valgus deformity of the knee.
Orthopedics.
1992;
15
1283-1289
-
100
Tinius M, Klima S, Marquass B, Tinius W, Josten C.
[Salvage procedures after failed unicompartmental knee arthroplasty - an analysis of 116 revisions].
Z Orthop Ihre Grenzgeb.
2006;
144
367-372
-
101
Toksvig-Larsen S, Magyar G, Onsten I, Ryd L, Lindstrand A.
Fixation of the tibial component of total knee arthroplasty after high tibial osteotomy: a matched radiostereometric study.
J Bone Joint Surg [Br].
1998;
80
295-297
-
102
Vaatainen U, Kiviranta I, Jaroma H, Airaksinen O.
Lateral release in chondromalacia patellae using clinical, radiologic, electromyographic, and muscle force testing evaluation.
Arch Phys Med Rehabil.
1994;
75
1127-1131
-
103 Vince K G, Malo M, Thandani P J. Posterior stabilization in total knee arthroplasty. Callaghan JJ, Rosenberg AG, Rubash HE, Simonian PT, Wickiewicz TL The Adult Knee. Philadelphia, Baltimore, New York, London, Buenos Aires, Hong Kong, Sydney, Tokyo; Lippincott Williams and Wilkins 2003: 1145-1162
-
104
Weale A E, Lee A S, MacEachern A G.
High tibial osteotomy using a dynamic axial external fixator.
Clin Orthop Relat Res.
2001;
382
154-167
-
105
Weidenhielm L, Olsson E, Brostrom L A, Borjesson-Hederstrom M, Mattsson E.
Improvement in gait one year after surgery for knee osteoarthrosis: a comparison between high tibial osteotomy and prosthetic replacement in a prospective randomized study.
Scand J Rehabil Med.
1993;
25
25-31
-
106
Weinrauch P, Myers N, Wilkinson M, Dodsworth J, Fitzpatrick P, Whitehouse S.
Comparison of early postoperative rehabilitation outcome following total knee arthroplasty using different surgical approaches and instrumentation.
J Orthop Surg (Hong Kong).
2006;
14
47-52
-
107
Whiteside L A.
Cementless total knee replacement. Nine- to 11-year results and 10-year survivorship analysis.
Clin Orthop Relat Res.
1994;
309
185-192
-
108
Winker K H, Weller S.
[Extra-ligamentous valgisation additive tibial head osteotomy. Indications - technic - complications - errors. Critical analysis].
Z Orthop Ihre Grenzgeb.
1990;
128
58-62
-
109
Zipper S G, Puschmann H.
[Nerve injuries after computer-assisted hip replacement: case series with 29 patients].
Z Orthop Ihre Grenzgeb.
2005;
143
399-402
-
110
Zorman D, Etuin P, Jennart H, Scipioni D, Devos S.
Computer-assisted total knee arthroplasty: comparative results in a preliminary series of 72 cases.
Acta Orthop Belg.
2005;
71
696-702
Dr. med. Gunter Spahn
Praxisklinik für Unfallchirurgie und Orthopädie
Sophienstraße 16
99817 Eisenach
Phone: 0 36 91/7 35 00
Fax: 0 36 91/73 50 11
Email: spahn@pk-eisenach.de
