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Sprunggelenkendoprothetik

Kriterien für eine patientenorientierte Entscheidung

Total ankle arthroplasty

Criteria for a patient-oriented decision

  • Standards in der Unfallchirurgie
  • Published:
Trauma und Berufskrankheit

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Zusammenfassung

Outcome

Durch die Entwicklung moderner, Knochen sparender 3-Komponenten-Prothesenmodelle, Fortschritte in der Operationstechnik und einem besseren Verständnis begleitender Pathologien verbesserten sich die Ergebnisse der Sprunggelenkendoprothetik in den letzten Jahren entscheidend. Gegenüber der primären Versteifung lässt sich ein signifikanter Funktionsgewinn erreichen, und die kumulative 5-Jahres-Prothesen-Überlebensrate kann mittlerweile auf über 90 % geschätzt werden.

Komplikationen

Die Komplikationsrate der Sprunggelenkendoprothetik muss weiterhin als hoch bezeichnet werden. Sekundäre Arthrodesen nach totalendoprothetischer Versorgung des oberen Sprunggelenks (OSG-TEP) sind in der Literatur in über 5 % aller Fälle dokumentiert und gegenüber der primären Versteifung aufgrund des Knochenverlusts nach Prothesenexplantation deutlich erschwert.

Schlussfolgerung

Voraussetzung für eine langfristig erfolgreiche endoprothetische Versorgung sind neben der exakten Positionierung der Prothese ein weichteilschonendes Operieren und die ein- oder zweizeitige Korrektur begleitender Bandinstabilitäten und Achsfehlstellungen. Von besonderer Bedeutung sind die korrekte Patientenauswahl und Indikationsstellung. Neben der Ätiologie müssen Patientenalter, Compliance, Aktivitätsniveau, OSG-Beweglichkeit, Durchblutungs- und Weichteilverhältnisse sowie Anschlussarthrosen berücksichtigt werden. Die vorhandenen Daten wissenschaftlicher Publikationen sind hierbei nur bedingt hilfreich.

Abstract

Outcome

In ankle arthoplasty considerable improvements have been made with the introduction of three component mobile bearing prostheses with biological fixation, advanced technical skills and a better understanding of concomitant pathologies. Ankle arthroplasty effectively improves pain and joint function in end-stage ankle arthritis and the weighted 5-year prosthesis survival rate can reasonably be estimated at 90 %.

Complications

Despite these improvements complication rates remain high. Arthrodesis after failed ankle joint replacement is much more complicated compared to primary ankle fusion and is necessary in over 5 % of cases.

Conclusion

Sufficient long-term results after ankle replacement surgery implies exact implant positioning, a tissue-protecting operation technique as well as a single or two stage correction of concomitant ligament instability and axial malalignment. Careful patient selection is of particular importance. The etiology as well as the age of the patient, compliance, level of activity, ankle range of movement, blood perfusion, soft tissue condition as well as associated arthritis of the adjacent joints must be taken into consideration. In this connection data provided by the current literature are of limited assistance.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. K. Bauwens, L. Bröcker und J. Strehle geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Orthopädie und Unfallchirurgie in Berlin-Mitte, Weydinger Straße 12, 10178, Berlin, Deutschland

    K. Bauwens & L. Bröcker

  2. Klinik für Unfallchirurgie und Orthopädie, Unfallkrankenhaus Berlin (ukb), Berlin, Deutschland

    K. Bauwens

  3. Fusszentrum Bern, Bern, Schweiz

    J. Strehle

  4. Centre du pied Fribourg, Fribourg, Schweiz

    J. Strehle

Authors
  1. K. Bauwens
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  2. L. Bröcker
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  3. J. Strehle
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Correspondence to K. Bauwens.

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Bauwens, K., Bröcker, L. & Strehle, J. Sprunggelenkendoprothetik . Trauma Berufskrankh 15, 184–192 (2013). https://doi.org/10.1007/s10039-013-2005-y

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  • DOI: https://doi.org/10.1007/s10039-013-2005-y

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