Weichteilmanagement in der primären Kniegelenkendoprothetik: konventionelle Techniken, Navigation und sensorintegrierte Messsysteme

Zusammenfassung

Das Weichteilmanagement spielt für den Erfolg einer Kniegelenktotalendoprothese eine entscheidende Rolle. In Kombination mit den knöchernen Resektionen und der Positionierung der femoralen und tibialen Komponenten soll durch den Ausgleich einer präoperativen kapsuloligamentären Dysbalance eine stabile Gelenkführung über den gesamten Flexionsbogen erreicht werden. Es werden verschiedene „Philosophien“ zum Weichteilmanagement in Bezug auf die Technik, das Timing und die Taktik beschrieben. Bisher fehlen dem Operateur jedoch objektive Messinstrumente zur intraoperativen Beurteilung dieser komplexen Zusammenhänge. Darüber hinaus ist das Wissen über die „ideale“ kapsuloligamentäre Stabilität nach einer Knieendoprothese noch gering. Im Rahmen des Forschungsprogramms „OrthoMIT“ (Minimal invasive Orthopädische Therapie) soll daher eine Kombination der konventionellen Techniken zum Weichteilmanagement, der Navigation und von sensorintegrierten Messsystemen technisch realisiert werden. Dieses stellt die Basis zur Entwicklung eines Instrumentes dar, welches sowohl in Fragen der Grundlagenforschung als auch zur intraoperativen Anwendung genutzt werden kann.

Abstract

Soft-tissue management is essential for the outcome in total knee arthroplasty. In combination with osseous resections and component positioning, correction of the underlying ligamentous dysbalance should yield a stable joint throughout the flexion arc. Different “philosophies” with regard to technique, timing and tactics in ligament balancing are described. So far, surgeons have not been provided with standardised devices that allow the objective measurement of this complex issue. Moreover, knowledge concerning the “ideal” soft-tissue stability following knee arthroplasty is still sparse. As part of the scientific project “OrthoMlT” (minimal invasive orthopaedic therapy) an approach to combine conventional soft-tissue management with navigation and force-sensing devices should be realized technically. The aim is to develop an instrument for the objective measurement of soft-tissue management in scientific and clinical applications.

Kniegelenkprothese - Weichteilmanagement - Extensionsspalt - Flexionsspalt - Navigation - sensorintegriertes Messsystem

knee arthroplasty - soft tissue management - extension gap - flexion gap - navigation - force‐sensing device

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