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Die Extension-First-Technik bei der Knie-TEP-Implantation

Extension first technique for TKA implantation

  • Operative Techniken
  • Published:
Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Reduktion von Implantationsfehlern bezüglich Rotation und Alignement bei endoprothetischem Kniegelenksersatz.

Indikationen

Symptomatische Gonarthrose.

Kontraindikationen

Allgemeine Kontraindikationen für Knietotalendoprothesen.

Operationstechnik

Knöcherne Präparation beginnend mit distalem Femurschnitt. Nachfolgend proximaler Tibiaschnitt und nach Kontrolle des korrekten Alignements Balancierung in Streckstellung. Knochenreferenzierte Positionierung des femoralen Schnittblocks zur weiteren Präparation des Femur. Rotationskontrolle in 90°-Beugung anhand der Weichteilspannung. Gegebenenfalls Überprüfung der Rotation bzw. Balancierung des Beugespalts.

Weiterbehandlung

Mobilisierung mit schmerzorientierter Vollbelastung der operierten Extremität und Freigabe der Beweglichkeit.

Ergebnisse

In einer prospektiven Studie wurden 267 Knieendoprothesen (160 Frauen, 107 Männer in einem Durchschnittsalter von 69,3 [46–89] Jahren) präoperativ und 6 Wochen postoperativ klinisch und radiologisch nachuntersucht. Bei der klinischen Untersuchung wurde der „Knee Society Score“ nach Insall und Scott sowie der funktionelle Score verwendet. Der präoperative Wert von 45,6 (32–66) konnte nach 6 Wochen auf 88,5 (77–100) gesteigert werden, der funktionelle Score von 48,9 (32–68) auf 86,5 (75–100). Radiologisch zeigten 92,1% einen Implantationsfehler <3°.

Abstract

Objective

Surgical technique in total knee arthroplasty (TKA) to combine the femur first and tibia first techniques in order to reduce surgical mistakes regarding rotation and alignment.

Indications

Symptomatic arthritis of the knee.

Contraindications

General contraindications for TKA.

Surgical technique

Osseous preparation starting with a distal femur cut. Then the proximal tibia cut is accomplished and the knee is balanced in extension after checking for correct alignment. Bone-referenced positioning of the femoral cutting block for further preparation of the femur. Finally, the rotation of the femur is checked in 90° of flexion by means of ligament tension. If required, the rotation is checked and the flexion gap balanced, respectively.

Postoperative management

Mobilization with weight bearing and range of motion as tolerated.

Results

In a prospective study, 267 knees (160 women, 107 men, average age of 69.3 [46–89] years) were followed up preoperatively and after 6 weeks. The clinical results were based on the American Knee Society score. The scores were 48.9 (32–68) preoperatively and 86.5 (75–100) at follow-up. Radiologically 92.1% of the knees showed a malposition <3°.

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Authors and Affiliations

  1. OCM-Klinik München, Steiner Str. 6, 81369, München, Deutschland

    R. Hube, H.O. Mayr & T. Kalteis

  2. Orthopädische Klinik Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    G. Matziolis

Authors
  1. R. Hube
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  2. H.O. Mayr
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  3. T. Kalteis
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  4. G. Matziolis
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Correspondence to R. Hube.

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Hube, R., Mayr, H., Kalteis, T. et al. Die Extension-First-Technik bei der Knie-TEP-Implantation. Oper Orthop Traumatol 23, 241–248 (2011). https://doi.org/10.1007/s00064-011-0036-8

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