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Erschienen in: Der Orthopäde 5/2014

01.05.2014 | Leitthema

Update Navigation in der Knieendoprothetik

Wo stehen wir heute und was bringt die Zukunft?

verfasst von: PD. Dr. T. Renkawitz, S. Winkler, M. Weber, F. von Kunow, J. Grifka, C. Baier

Erschienen in: Die Orthopädie | Ausgabe 5/2014

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Zusammenfassung

Hintergrund

Die Implantation eines künstlichen Kniegelenks gehört zu den häufigsten operativen Eingriffen in deutschen Krankenhäusern. Navigationsverfahren haben sich dabei in den Operationssälen vieler Kliniken zu einem integralen Bestandteil entwickelt.

Methoden

Orthopädische Chirurgen, die eine möglichst genaue Rekonstruktion der mechanischen Beinachse umsetzen möchten und eine intraoperative Kontrolle der dreidimensionalen Komponentenposition und/oder der kapsulär-ligamentären Situation wünschen, finden in der Navigation ein probates intraoperatives Hilfsmittel. Die unmittelbare intraoperative Kontrollmöglichkeit von knöchernen Resektionen und des kapsulär-ligamentären Weichteilbalancings machen die Navigation darüber hinaus zu einem wertvollen Instrument für das biomechanische Grundverständnis bei Ausbildungsoperationen für Weiterbildungsassistenten.

Entwicklungen

Die größere Präzision bei der Anwendung des Verfahrens spiegelt sich bislang nicht mehrheitlich in einer verbesserten postoperativen Kniefunktion oder einer höheren Standzeit der Kunstgelenke wider. Neue Entwicklungen in der navigierten Knieendoprothetik stellen die pinfreie Navigation und die Navigationskinematik dar. Bei der pinfreien („pinless“) Navigation wird das konventionell im Oberschenkel- und Schienbeinknochen befestigte Referenzmarkersystem durch ein nichtinvasives Referenzsystem ersetzt. Mithilfe der Navigationskinematik besteht die Möglichkeit, die tibiofemorale sowie patellofemorale Bewegungsdynamik intraoperativ abzubilden.

Ausblick

Ziel der nächsten Generation von Navigationssystemen für die computerassistierte Knieendoprothetik ist eine an der patientenindividuellen Anatomie ausgerichtete Implantatpositionierung mit hohem/stabilem Bewegungsumfang bei optimierter patellarer Führung und Kinematik des Kunstgelenks.
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Metadaten
Titel
Update Navigation in der Knieendoprothetik
Wo stehen wir heute und was bringt die Zukunft?
verfasst von
PD. Dr. T. Renkawitz
S. Winkler
M. Weber
F. von Kunow
J. Grifka
C. Baier
Publikationsdatum
01.05.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Orthopädie / Ausgabe 5/2014
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI
https://doi.org/10.1007/s00132-013-2193-y

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