Minimalinvasive Zugänge am Kniegelenk – evidenzbasierter Vorteil in der Knieendoprothetik?^[*]

 

 Buy Article Permissions and Reprints

Zusammenfassung

Im Rahmen der vorliegenden Übersichtsarbeit wird die Anwendung von minimalinvasiven Operationstechniken zur Implantation einer Knieendoprothese schrittweise nach Kriterien der evidenzbasierten Medizin bewertet. Dafür ist die Formulierung einer patientenrelevanten, beantwortbaren Frage wesentlich. Diese lautet z. B. in diesem Zusammenhang: „Haben Patienten mit fortgeschrittener Gonarthrose bei Nutzung eines minimalinvasiven Zugangs zur Implantation einer Knieendoprothese eine kürzere Rehabilitation als Patienten, bei denen der Standardzugang verwendet wurde?“ Die vorhandene Literatur wird nach Studienqualität und möglichen Verzerrungen geordnet und bewertet. Metaanalysen basierend auf klinischen Studien deuten zunächst auf eine positive Beantwortung hin. Unter dem Gesichtspunkt einer systematischen Weiterentwicklung von chirurgischen Verfahren ist der Stellenwert von minimalinvasiven Operationstechniken in der Routineversorgung noch nicht abschließend zu beurteilen: Die vermehrt berichteten Komplikationen bei Anwendung von minimalinvasiven Operationstechniken führen zu einer zurückhaltenden Bewertung: Ein genereller Vorteil ist nicht vorhanden. Weitere Studien zu Lernkurven, Patientenselektion und Patientenpräferenzen sind erforderlich, bevor der Stellenwert von minimalinvasiven Operationsverfahren in der Knieendoprothetik eingeordnet werden kann.

Abstract

The impact of minimally invasive surgical techniques for implantation of a total knee arthroplasty is evaluated according to evidence-based medicine criteria. The patient-relevant clinical question can be formulated as: Is the rehabilitation of osteoarthritis patients with minimally invasive implantation of total knee arthroplasty faster compared to those with the conventional approach. The available literature is sorted and critically appraised with regard to methodological quality and risk of bias. Following the results of the meta-analyses the clinical question can be positively answered. Following the aspect of a structured evolution for surgical techniques, the meaning of a minimally invasive technique for total knee arthroplasty cannot be answered finally. Under the impression of more frequent surgical complications, the rating of the procedure is conservative. A general advantage is not apparent. Further studies investigating surgical learning curves, proper patient selection and the selection of the patient for such techniques are required, before the final judgement on the use of this technique can be formed.

^* Nach einem Vortrag vom Sektionstag der Arbeitsgemeinschaft für Endoprothetik DKOU 2012.

• Literatur

• 1 Sackett DL, Richardson WS, Rosenberg W et al. 1. Wie man eine beantwortbare Frage stellt. In: Kunz R, Fritsche L, Hrsg. Evidenzbasierte Medizin. Bern, Wien, New York: Zuckschwerdt; 1999: 19-30
  CrossrefGoogle Scholar
• 2 Richardson WS, Wilson MC, Nishikawa J et al. The well-built clinical question: a key to evidence-based decisions. ACP J Club 1995; 123: A12-A13
  PubMedGoogle Scholar
• 3 Sackett DL, Rosenberg WM, Gray JA et al. Evidence based medicine: what it is and what it isnʼt. BMJ 1996; 312: 71-72
  Google Scholar
• 4 Engelhardt DM, Margolis RA, Rudorfer L et al. Physician bias and the double-blind. Arch Gen Psychiatry 1969; 20: 315-320
  CrossrefPubMedGoogle Scholar
• 5 Sacks HS, Berrier J, Reitman D et al. Meta-analyses of randomized controlled trials. N Engl J Med 316: 450-455
  PubMedGoogle Scholar
• 6 Liberati A, Altman DG, Tetzlaff J et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009; 6: e1000100
  CrossrefPubMedGoogle Scholar
• 7 Moher D, Cook DJ, Eastwood S et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet 1999; 354: 1896-1900
  CrossrefPubMedGoogle Scholar
• 8 NIH Consensus Panel. NIH Consensus Statement on total knee replacement December 8–10, 2003. J Bone Joint Surg Am 2004; 86: 1328-1335
  PubMedGoogle Scholar
• 9 Schai PA, Thornhill TS, Scott RD. 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
  CrossrefPubMedGoogle Scholar
• 10 Dunbar MJ. Subjective outcomes after knee arthroplasty. Acta Orthop Scand Suppl 2007; 72: 1-63
  PubMedGoogle Scholar
• 11 Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: just how important is it?. J Arthroplasty 2009; 24 (6 Suppl.) S39-S43
  PubMedGoogle Scholar
• 12 Bauwens K, Matthes G, Wich M et al. Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 2007; 89: 261-269
  CrossrefPubMedGoogle Scholar
• 13 Quack VM, Kathrein S, Rath B et al. Computer-assisted navigation in total knee arthroplasty: a review of literature. Biomed Tech (Berl) 2012; 57: 269-275
  PubMedGoogle Scholar
• 14 Knieendoprothesenversorgung: Gemeinsamer Bundesausschuss, AQUA – Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, 2012. Im Internet: http://www.sqg.de/sqg/upload/CONTENT/Neue-Verfahren/Endoprothetik-Knie/Anlagen_Knieendoprothesenversorgung.pdf Stand: 20.09.2013
  PubMedGoogle Scholar
• 15 Hartel W, Ekkernkamp A. Kongressbericht: Zunehmender Einsatz der minimalinvasiven Chirurgie. Dt Ärztebl 2002; 99: A1306-A1310
  PubMedGoogle Scholar
• 16 Jähne J. Update Magenchirurgie Sind Neuerungen wirklich immer besser?. Chirurg 2012; 83: 7-8
  CrossrefPubMedGoogle Scholar
• 17 Gross M. Innovations in surgery. A proposal for phased clinical trials. J Bone Joint Surg Br 1993; 75: 351-354
  PubMedGoogle Scholar
• 18 Malchau H. Introducing new technology: a stepwise algorithm. Spine (Phila Pa 1976) 2000; 25: 285
  CrossrefPubMedGoogle Scholar
• 19 Barkun JS, Aronson JK, Feldman LS et al. Evaluation and stages of surgical innovations. Lancet 2009; 374: 1089-1096
  CrossrefPubMedGoogle Scholar
• 20 McCulloch P, Altman DG, Campbell WB et al. No surgical innovation without evaluation: the IDEAL recommendations. Lancet 2009; 374: 1105-1112
  CrossrefPubMedGoogle Scholar
• 21 Lieberman JR, Wenger N. New technology and the orthopaedic surgeon: are you protecting your patients?. Clin Orthop Relat Res 2004; 429: 338-341
  CrossrefPubMedGoogle Scholar
• 22 Holt G, Wheelan K, Gregori A. The ethical implications of recent innovations in knee arthroplasty. J Bone Joint Surg Am 2006; 88: 226-229
  CrossrefPubMedGoogle Scholar
• 23 Karachalios T, Giotikas D, Roidis N et al. Total knee replacement performed with either a mini-midvastus or a standard approach: a prospective randomised clinical and radiological trial. J Bone Joint Surg Br 2008; 90: 584-591
  CrossrefPubMedGoogle Scholar
• 24 Leopold SS. Minimally invasive total knee arthroplasty for osteoarthritis. N Engl J Med 2009; 360: 1749-1758
  CrossrefPubMedGoogle Scholar
• 25 Kolisek FR, Bonutti PM, Hozack WJ et al. Clinical experience using a minimally invasive surgical approach for total knee arthroplasty: early results of a prospective randomized study compared to a standard approach. J Arthroplasty 2007; 22: 8-13
  PubMedGoogle Scholar
• 26 Engh GA, Holt BT, Parks NL. A midvastus muscle-splitting approach for total knee arthroplasty. J Arthroplasty 1997; 12: 322-331
  CrossrefPubMedGoogle Scholar
• 27 Hofmann AA, Plaster RL, Murdock LE. Subvastus (Southern) approach for primary total knee arthroplasty. Clin Orthop Relat Res 1991; 269: 70-77
  PubMedGoogle Scholar
• 28 Tria jr. AJ, Coon TM. Minimal incision total knee arthroplasty: early experience. Clin Orthop Relat Res 2003; 416: 185-190
  CrossrefPubMedGoogle Scholar
• 29 Coon TM. Specialized instruments and modular implants for minimally invasive total knee arthroplasty. Am J Orthop (Belle Mead NJ) 2006; 35: 12-17
  PubMedGoogle Scholar
• 30 Bonutti PM, Mont MA, McMahon M et al. Minimally invasive total knee arthroplasty. J Bone Joint Surg Am 2004; 86-A (Suppl. 02) S26-S32
  PubMedGoogle Scholar
• 31 Shankar NS. Minimally invasive technique in total knee arthroplasty – history, tips, tricks and pitfalls. Injury 2006; 37 (Suppl. 05) S25-S30
  PubMedGoogle Scholar
• 32 Dalury DF, Dennis DA. Mini-incision total knee arthroplasty can increase risk of component malalignment. Clin Orthop Relat Res 2005; 440: 77-81
  CrossrefPubMedGoogle Scholar
• 33 Hofmann S, Pietsch M. Entwicklung, Terminologie, Prinzipien und Kontroversen bei der minimal-invasiven Knieendoprothetik. Orthopade 2007; 36: 1086-1092
  PubMedGoogle Scholar
• 34 Dabboussi N, Sakr M, Girard J et al. Minimally invasive total knee arthroplasty: a comparative study to the standard approach. N Am J Med Sci 2012; 4: 81-85
  CrossrefPubMedGoogle Scholar
• 35 Ohnsorge JA, Laskin RS. [Special surgical technique of minimally invasive total knee replacement]. Z Orthop Ihre Grenzgeb 2006; 144: 91-96
  Article in Thieme ConnectPubMedGoogle Scholar
• 36 Santini AJ, Raut V. Ten-year survival analysis of the PFC total knee arthroplasty–a surgeonʼs first 99 replacements. Int Orthop 2008; 32: 459-465
  CrossrefPubMedGoogle Scholar
• 37 Smith BR, Deakin AH, Baines J et al. Computer navigated total knee arthroplasty: the learning curve. Comput Aided Surg 2010; 15: 40-48
  CrossrefPubMedGoogle Scholar
• 38 Jenny JY, Miehlke RK, Giurea A. Learning curve in navigated total knee replacement. A multi-centre study comparing experienced and beginner centres. Knee 2008; 15: 80-84
  CrossrefPubMedGoogle Scholar
• 39 Coon TM. The economic impact of minimally invasive total knee arthroplasty. Am J Orthop (Belle Mead NJ) 2006; 35: 33-35
  CrossrefPubMedGoogle Scholar
• 40 King J, Stamper DL, Schaad DC et al. Minimally invasive total knee arthroplasty compared with traditional total knee arthroplasty. Assessment of the learning curve and the postoperative recuperative period. J Bone Joint Surg Am 2007; 89: 1497-1503
  CrossrefPubMedGoogle Scholar
• 41 Bonutti PM, Zywiel MG, Ulrich SD et al. Minimally invasive total knee arthroplasty: pitfalls and complications. Am J Orthop (Belle Mead NJ) 2010; 39: 480-484
  PubMedGoogle Scholar
• 42 Niki Y, Mochizuki T, Momohara S et al. Is minimally invasive surgery in total knee arthroplasty really minimally invasive surgery?. J Arthroplasty 2009; 24: 499-504
  CrossrefPubMedGoogle Scholar
• 43 Kelly MJ, Rumi MN, Kothari M et al. Comparison of the vastus-splitting and median parapatellar approaches for primary total knee arthroplasty: a prospective, randomized study. Surgical technique. J Bone Joint Surg Am 2007; 89 (Suppl. 02) S80-S92
  PubMedGoogle Scholar
• 44 Perka C, Tohtz S, Matziolis G. Achskorrektur bei Knietotalendoprothesenrevisionen. Orthopade 2006; 35: 136-142
  PubMedGoogle Scholar
• 45 Fehring TK, Mason JB. Catastrophic complications of minimally invasive hip surgery. A series of three cases. J Bone Joint Surg Am 2005; 87: 711-714
  CrossrefPubMedGoogle Scholar
• 46 Luring C, Tingart M, Beckmann J et al. Minimal-invasive Knieendoprothetik und Navigation – eine sinnvolle Kombination?. Orthopade 2007; 36: 1143-1148
  PubMedGoogle Scholar
• 47 Kappe T, Floren M, Bieger R et al. Aktueller Stellenwert der minimalinvasiven Knieendoprothetik. Orthopade 2011; 40: 726-730
  PubMedGoogle Scholar
• 48 Khanna A, Gougoulias N, Longo UG et al. Minimally invasive total knee arthroplasty: a systematic review. Orthop Clin North Am 2009; 40: 479-489
  CrossrefPubMedGoogle Scholar
• 49 Marx RG, Jones EC, Atwan NC et al. Measuring improvement following total hip and knee arthroplasty using patient-based measures of outcome. J Bone Joint Surg Am 2005; 87: 1999-2005
  CrossrefPubMedGoogle Scholar
• 50 Wulker N, Lambermont JP, Sacchetti L et al. A prospective randomized study of minimally invasive total knee arthroplasty compared with conventional surgery. J Bone Joint Surg Am 2010; 92: 1584-1590
  CrossrefPubMedGoogle Scholar
• 51 Nelson J. Joshua Nelson, MD, PharmD, on “A prospective randomized study of minimally invasive total knee arthroplasty compared with conventional surgery” by Nikolaus Wulker, PhD, MD, et al. J Bone Joint Surg Am 2010; 92: e3
  PubMedGoogle Scholar
• 52 Vavken P, Gruber M, Dorotka R. [Outcomes after minimally invasive total knee replacement–a meta-analysis]. Z Orthop Unfall 2008; 146: 768-772
  Article in Thieme ConnectPubMedGoogle Scholar
• 53 Cheng T, Liu T, Zhang G et al. Does minimally invasive surgery improve short-term recovery in total knee arthroplasty?. Clin Orthop Relat Res 2010; 468: 1635-1648
  CrossrefPubMedGoogle Scholar
• 54 Alcelik I, Sukeik M, Pollock R et al. Comparison of the minimally invasive and standard medial parapatellar approaches for primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012; 20: 2502-2512
  CrossrefPubMedGoogle Scholar
• 55 Smith TO, King JJ, Hing CB. A meta-analysis of randomised controlled trials comparing the clinical and radiological outcomes following minimally invasive to conventional exposure for total knee arthroplasty. Knee 2012; 19: 1-7
  CrossrefPubMedGoogle Scholar
• 56 Kirschner S. [Studien zum therapeutischen Nutzen von Medizinprodukten in O + U Kommentierte Praxisbeispiele] . Z Evid Fortbild Qual Gesundhwes 2012; 106: 342-346
  CrossrefPubMedGoogle Scholar
• 57 Juni P, Nartey L, Reichenbach S et al. Risk of cardiovascular events and rofecoxib: cumulative meta-analysis. Lancet 2004; 364: 2021-2029
  CrossrefPubMedGoogle Scholar
• 58 Gandhi R, Smith H, Lefaivre KA et al. Complications after minimally invasive total knee arthroplasty as compared with traditional incision techniques: a meta-analysis. J Arthroplasty 2011; 26: 29-35
  CrossrefPubMedGoogle Scholar
• 59 Kim TK, Choi J, Shin KS et al. Patientsʼ perspective on controversial issues in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2008; 16: 297-304
  CrossrefPubMedGoogle Scholar
• 60 Sackett DL. Clinician-trialist rounds: 5. Cointervention bias–how to diagnose it in their trial and prevent it in yours. Clin Trials 2011; 8: 440-442
  CrossrefPubMedGoogle Scholar
• 61 Pour AE, Parvizi J, Sharkey PF et al. Minimally invasive hip arthroplasty: what role does patient preconditioning play?. J Bone Joint Surg Am 2007; 89: 1920-1927
  CrossrefPubMedGoogle Scholar
• 62 Essving P, Axelsson K, Otterborg L et al. Minimally invasive surgery did not improve outcome compared to conventional surgery following unicompartmental knee arthroplasty using local infiltration analgesia: a randomized controlled trial with 40 patients. Acta Orthop 2012; 83: 634-641
  CrossrefPubMedGoogle Scholar