Z Orthop Ihre Grenzgeb 2000; 138(3): 204-208
DOI: 10.1055/s-2000-11275
KNIEENDOPROTHETIK

Georg Thieme Verlag Stuttgart · New York

Ist die unikondyläre Knieprothese eine zeitgemäße Möglichkeit der Primärversorgung bei Varusgonarthrose? - Eine prospektive matched-pair-Studie

Clinical Medium-Term Results with the Cementless Unconstrained Total Knee Replacement (Type Natural Knee) in Comparison with Sledge Prosthesis for Unicompartmental Knee Replacement (Type Wessinghage).M.  Meyer, A.  Machner, G.  Pap, H.  W.  Neumann
  • Orthopädische Universitätsklinik Magdeburg
Further Information

Publication History

Publication Date:
31 December 2000 (online)

Zusammenfassung.

Studienziel: In der vorliegenden Studie wurde eine Follow-up-Untersuchung der mittelfristigen Ergebnisse nach unikondylären und bikondylären Knie-TEP mittels matched-pair-Vergleich durchgeführt. Material und Methoden: Dabei wurden zwei Gruppen mit jeweils 18 Patienten nachuntersucht. In der ersten der beiden Gruppen waren Patienten mit einer unikondylären Schlittenprothese vom Typ Wessinghage, in der zweiten Patienten mit zementfreiem Oberflächenersatz vom Typ Natural knee. Die durchschnittliche Follow-up-Zeit betrug 4,5 Jahre (SD ± 0,6). Das Durchschnittsalter der Patienten beider Gruppen lag bei 59 Jahren (SD ± 3). In beiden Gruppen waren je 12 weibliche und 6 männliche Patienten. Alle Patienten litten unter primärer Varusgonarthrose. In allen Fällen wies auch die Gegenseite Zeichen einer manifesten Gonarthrose auf. Die Erfassung und Bewertung der Ergebnisse erfolgte nach dem Score der Amerikanischen Knee-Society. Zusätzlich erfolgte eine radiologische Befundung mit Beurteilung des Prothesensitzes, der Lysesäume und der Patellaposition. Ergebnisse: Der mittlere Knie-Score zeigte keine signifikanten Unterschiede bei Patienten mit zementfreiem Oberflächenersatz und Patienten mit unikondylären Schlittenprothesen. In der Tendenz wiesen Patienten mit Schlittenprothese sogar bessere Ergebnisse auf. Die durchschnittlichen Ergebnisse des Knie-Scores waren 94,3 (SD ± 4,9) in der Wessinghage-Gruppe und 91,9 (SD ± 8,3) in der Natural-Knee-Gruppe. In der Gruppe mit Oberflächenersatz wurden bei der radiologischen Auswertung keine Lysesäume gefunden, in der Gruppe mit unikondylärem Ersatz fanden wir in 7 Fällen Lysesäume von 1 mm oder mehr im Bereich des Tibiateils. In keinem dieser Fälle jedoch traten klinische Symptome auf. Schlussfolgerung: Unsere Ergebnisse zeigen, dass die Implantation unikondylärer medialer Schlittenprothesen eine effektive Methode zur Versorgung bei primärer Varusgonarthrose darstellt, auch in Hinsicht auf eventuelle Wechseloperationen.

Aim: In the present study, we performed a follow-up investigation comparing middle-term results after unicompartmental and bicompartmental knee arthroplasties. Material and Methods: We used matched pairs with 18 patients in each group. The first group was treated with the unicompartmental slegde prosthesis (Type Wessinghage), the second with the cementless nonconstrained bicondylar prosthesis (Type Natural knee). The mean time of follow-up was 4.5 years. (SD ± 0.6). The average age of the patients in both groups was 59 years (SD ± 3). Both groups included 12 female and 8 male patients. All patients suffered from primary medial osteoarthritis of the knee. In all cases, the contralateral knee also had signs of manifest osteoarthritis. The determination and evaluation of the results of the investigation were made according to the score of the American Knee Society. We also reviewed the radiological findings concerning placement of the prosthesis, radiolucent lines, and patella position in the femoral shield. Results: At follow-up examination, there were no significant differences in the knee score between the patients undergoing unicompartmental or total knee replacement. However, patients with the Wessinghage sledge tended to show better results. The mean knee score was 94.3 ± 4.9 in the Wessinghage group and 91.9 ± 8.3 in the Natural knee group. Evaluation of the radiographs revealed radiolucent lines in the group with total replacement. In contrast, in 7 of 18 patients with the unicompartmental prostheses we found radiolucent lines at the tibial component of 1 mm or more, which, however, did not cause clinical symptoms. Conclusion: Our results show, that the unicompartmental arthroplasty is still an effective method for the treatment of the osteoarthritis, especially concerning the conditions for possibly needed revisions.

Literatur

  • 01 Ansari  S, Newman  J H, Ackroyd  C E. St. Georg sledge for medial compartment knee replacement. 461 arthroplasties followed for 4 (1 - 17) years.  Acta Orthop Scand. 1997;;  68: 430-434
  • 02 Barrett  W P, Scott  R D. Revision of failed unicondylar unicompartmental knee arthroplasty.  J Bone Joint Surg [Am]. 1987;;  69-A
  • 03 Bassett  R W. Results of 1,000 Performance knees: cementless versus cemented fixation.  J Arthroplasty. 1998;;  13: 409-413
  • 04 Brinker  M R, Savory  C G, Weeden  S H, Aucoin  H C, Curd  D T. The results of total knee arthroplasty in workers' compensation patients.  Bull Hosp Jt Dis. 1998;;  57: 80-83
  • 05 Cameron  H U, Jung  Y B. Noncemented stem tibial component in total knee replacement: the 2- to 6-year results.  Can J Surg. 1993;;  36: 555-559
  • 06 Capra  S WJ, Fehring  T K. Unicondylar arthroplasty. A survivorship analysis.  J Arthroplasty. 1992;;  7: 247-251
  • 07 Carr  A, Keyes  G, Miller  R, O'Connor  J, Goodfellow  J. Medial unicompartmental arthroplasty. A survival study of the Oxford meniscal knee.  Clin Orthop. 1993;;  205-213
  • 08 Chakrabarty  G, Newman  J H, Ackroyd  C E. Revision of unicompartmental arthroplasty of the knee. Clinical and technical considerations.  J Arthroplasty. 1998;;  13: 191-196
  • 09 Chassin  E P, Mikosz  R P, Andriacchi  T P, Rosenberg  A G. Functional analysis of cemented medial unicompartmental knee arthroplasty.  J Arthroplasty. 1996;;  11: 553-559
  • 10 Duffy  G P, Trousdale  R T, Stuart  M J. Total knee arthroplasty in patients 55 years old or younger. 10- to 17-year results.  Clin Orthop. 1998;;  22-27
  • 11 Engh  G A, Dwyer  K A, Hanes  C K. Polyethylene Wear of Metal-Backed Tibial Components in Total and Unicompartmental Knee Prostheses.  J Bone Joint Surg. 1992;;  74-B: 9-17
  • 12 Eskola  A, Vahvanen  V, Santavirta  S, Honkanen  V, Slatis  P. Porous-coated anatomie (PCA) knee arthroplasty. 3-year results.  J Arthroplasty. 1992;;  7: 223-228
  • 13 Ewald  F C. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system.  Clin Orthop. 1989;;  9-12
  • 14 Gill  T, Schemitsch  E H, Brick  G W, Thornhill  T S. Revision total knee arthroplasty after failed unicompartmental knee arthroplasty or high tibial osteotomy.  Clin Orthop. 1995;;  10-18
  • 15 Goodfellow  J W, Kershaw  C J, Benson  M K, O'Connor  J J. The Oxford Knee for unicompartmental osteoarthritis. The first 103 cases.  J Bone Joint Surg [Br]. 1988;;  70: 692-701
  • 16 Hofmann  A A, Murdock  L E, Wyatt  R W, Alpert  J P. Total knee arthroplasty. Two- to four-year experience using an asymmetric tibial tray and a deep trochlear-grooved femoral component.  Clin Orthop. 1991a;;  78-88
  • 17 Hofmann  A A, Wyatt  R W, Beck  S W, Alpert  J. Cementless total knee arthroplasty in patients over 65 years old.  Clin Orthop. 1991b;;  28-34
  • 18 Insall  J, Aglietti  P. A five to seven-year follow-up of unicondylar arthroplasty.  J Bone Joint Surg [Am]. 1980;  62: 1329-1337
  • 19 Insall  J, Walker  P. Unicondylar knee replacement.  Clin Orthop. 1976;;  00; 83-85
  • 20 Insall  J N, Dorr  L D, Scott  R D, Scott  W N. Rationale of the Knee Society clinical rating system.  Clin Orthop. 1989;;  248: 13-14
  • 21 Jackson  R W. Surgical treatment. Osteotomy and unicompartmental arthroplasty.  Am J Knee Surg. 1998;;  11: 55-57
  • 22 Jäger  M, Wirth  C J. Praxis der Orthopädie.  In: Anonymous Thieme. Stuttgart New York; 1986
  • 23 Kienapfel  H, Griss  P, Roloff  K, Malzer  U. Zwei- bis Fünfjahresergebnisse mit der zementfrei einsetzbaren Kniegelenkprothese vom Typ Miller-Galante.  Orthopäde. 1991;;  20: 189-196
  • 24 Knight  J L, Atwater  R D, Grothaus  L. Clinical results of the modular porous-coated anatomie (PCA) total knee arthroplasty with cement: a 5-year prospective study.  Orthopedics. 1997a;;  20: 1025-1033
  • 25 Knight  J L, Atwater  R D, Guo  J. Early failure of the porous coated anatomic cemented unicompartmental knee arthroplasty. Aids to diagnosis and revision.  J Arthroplasty. 1997b;;  12: 11-20
  • 26 Konig  A, Scheidler  M, Rader  C, Haase  M, Eulert  J. [ls use of the Knee Society Roentgenographie Evaluation and Scoring System for radiologie control of knee prostheses reliable?].  Z Orthop Ihre Grenzgeb. 1998;;  136: 70-76
  • 27 Lai  C H, Rand  J A. Revision of failed unicompartmental total knee arthroplasty.  Clin Orthop. 1993;;  193-201
  • 28 Larsson  S E, Larsson  S, Lundkvist  S. Unicompartmental knee arthroplasty. A prospective consecutive series followed for six to 11 years.  Clin Orthop. 1988;;  174-181
  • 29 Laskin  R S. Total knee arthroplasty using an uncemented, polyethylene tibial implant. A seven-year follow-up study.  Clin Orthop. 1993;;  270-276
  • 30 Laurencin  C T, Zelicof  S B, Scott  R D, Ewald  F C. Unicompartmental versus total knee arthroplasty in the same patient. A comparative study.  Clin Orthop. 1991;;  151-156
  • 31 Magnussen  P A, Banlett  R J. Cementless PCA unicompartmental joint arthroplasty for osteoarthritis of the knee. A prospective study of 51 cases.  J Arthroplasty. 1990;;  5: 151-158
  • 32 Mallory  T H, Danyi  J. Unicompartmental total knee arthroplasty. A five- to nine-year follow-up study of 42 procedures.  Clin Orthop. 1983;;  135-138
  • 33 Marmor  L. Unicompartmental and total knee arthroplasty.  Clin Orthop. 1985;;  75-81
  • 34 Murray  D W, Goodfellow  J W, O'Connor  J J. The Oxford medial unicompartmental arthroplasty: a ten-year survival study.  J Bone Joint Surg Br. 1998;;  80: 983-989
  • 35 Newman  J H, Ackroyd  C E, Shah  N A. Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicompartmental arthritis.  J Bone Joint Surg Br. 1998;;  80: 862-865
  • 36 Otte  K S, Larsen  H, Jensen  T T, Hansen  E M, Rechnagel  K. Cementless AGC revision of unicompartmental knee arthroplasty.  J Arthroplasty. 1997;;  12: 55-59
  • 37 Padgett  D E, Stern  S H, Insall  J N. Revision total knee arthroplasty for failed unicompartmental replacement.  J Bone Joint Surg (Am). 1991;;  73: 186-190
  • 38 Palmer  S H, Morrison  P J, Ross  A C. Early catastrophic tibial component wear after unicompartmental knee arthroplasty.  Clin Orthop. 1998;;  143-148
  • 39 Pap  G, Liebau  C, Merk  H, Neumann  H W. Mittelfristige Ergebnisse mit dem zementlosen, ungekoppelten Oberflächenersatz vom Typ Natural Knee.  Orthop Praxis. 1996;;  32: 543-548
  • 40 Rougraff  B T, Heck  D A, Gibson  A E. A comparison of tricompartmental and unicompartmental arthroplasty for the treatment of gonarthrosis.  Clin Orthop. 1991;;  273: 157-164
  • 41 Schai  P A, Thornhill  T S, Scott  R D. 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
  • 42 Scott  R D, Cobb  A G, McQueary  F G, Thornhill  T S. Unicompartmental knee arthroplasty. Eight- to 12-year follow-up evaluation with survivorship analysis.  Clin Orthop. 1991;;  96-100
  • 43 Sisto  D J, Blazina  M E, Heskiaoff  D, Hirsh  L C. Unicompartment arthroplasty for osteoarthrosis of the knee.  Clin Orthop. 1993;;  149-153
  • 44 Swank  M, Stulberg  S D, Jiganti  J, Machairas  S. The natural history of unicompartmental arthroplasty. An eight-year follow-up study with survivorship analysis.  Clin Orthop. 1993;;  130-142
  • 45 Tabor  O BJ, Tabor  O B. Unicompartmental arthroplasty: a long-term follow-up study.  J Arthroplasty. 1998;;  13: 373-379
  • 46 Uematsu  O, Hsu  H P, Kelley  K M, Ewald  F C, Walke  P S. Radiographie study of Kinematic total knee arthroplasty.  J Arthroplasty. 1987;;  2: 317-326
  • 47 Walter  H, Kawashima  A, Nebelung  W, Neumann  W. Immunohistochemical Analysis of Several Proteolytic Enzymes as Parameters of Cartilage Degradation.  Path Res Pract. 1998;;  194: 73-81
  • 48 Whiteside  L A. Cementless total knee replacement. Nine- to 11-year results and 10-year survivorship analysis.  Clin Orthop. 1994;;  185-192

Dr. med. Margit Meyer

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