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Z Orthop Ihre Grenzgeb 2006; 144(2): 164-171
DOI: 10.1055/s-2006-921540
Kniegelenk

© Georg Thieme Verlag Stuttgart · New York

In-vitro-Untersuchung der Spannung des hinteren Kreuzbandes nach primärer Knieendoprothetik

Vergleich fixes versus mobiles DesignIn Vitro Investigation of Posterior Cruciate Ligament Strain Following Total Knee ArthroplastyComparison of Fixed Versus Mobile DesignT. Siebel1 , W. Käfer2
  • 1Orthopädische Klinik, Knappschaftskrankenhaus Püttlingen, Püttlingen
  • 2Orthopädische Universitätsklinik am RKU, Ulm
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Publikationsverlauf

Publikationsdatum:
19. April 2006 (online)

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Zusammenfassung

Einleitung: Ziel der biomechanischen Kadaverstudie war es, die Spannung des hinteren Kreuzbandes (HKB) nach Implantation einer Knietotalendoprothese im Vergleich eines fixen und eines mobilen Designs zu untersuchen und dabei die Veränderung des tibialen Slope zu berücksichtigen. Material und Methodik: Acht Natural Knee-I (NK-I) Endoprothesen mit fixem Inlay und acht Low Contact Stress (LCS) Endoprothesen mit mobilen Meniskallagern wurden in humane Kadaverkniegelenke implantiert. Die Spannung des HKB wurde mit Dehnungsmessstreifen analysiert. Die Kniegelenkkinematik wurde mit einem Kniebelastungsprüfstand, der über alle sechs Freiheitsgrade des Kniegelenks verfügt, mit (300 Newton) und ohne Lastapplikation untersucht. Die Veränderung des tibialen Slope wurde radiologisch bestimmt. Die statistische Analyse erfolgte mittels Student-t-Test, Wilcoxon Rangsummen-Test und Spearman-Korrelationsanalyse. Ergebnisse: Postoperativ zeigte sich eine Zunahme des tibialen Slope um 2,1° (p = 0,14) bei der NK-I-Prothese bzw. 1,1° (p = 0,12) bei der LCS-Prothese. Die Analyse der HKB-Spannung nach Implantation der NK-I-Prothese zeigte mit (p = 0,74) und ohne Lastapplikation (p = 0,20) nur geringfügige Modifikationen, während es nach Implantation der LCS-Prothese im belasteten Zyklus zu einem signifikanten Spannungsabfall (p = 0,01) kam; unbelastet zeigte die LCS-Prothese eine nahezu unveränderte HKB-Spannung (p = 1,0). Die Korrelationsanalyse der Modifikation von tibialem Slope und HKB-Spannung zeigte einen substanziellen Zusammenhang bei der NK-I-Prothese (unbelastet rs = 0,70, belastet rs = 0,64), im Fall der LCS-Prothese allerdings nur einen geringen (unbelastet rs = - 0,43) bzw. keinen Zusammenhang (belastet rs = 0,01). Schlussfolgerung: Die NK-I-Endoprothese lässt ein nahezu unverändertes Spannungsmuster des HKB zu, was dem Postulat einer prinzipiellen Irregularität der Kreuzbandspannung nach Knieendoprothetik widerspricht. Das Ausmaß der Kreuzbandspannung wird wesentlich von der Interaktion zwischen Design der Endoprothese (u. a. Mobilität des Inlays) und funktioneller Rolle des HKB bestimmt.

Abstract

Aim: The aim of this biomechanical in vitro study was to assess posterior cruciate ligament (PCL) strain following two different total knee arthroplasty (TKA) designs (fixed versus mobile) with regard to modification of the tibial slope. Material and Methods: We investigated eight Natural Knee I (NK I) prosthesis with fixed bearing and eight Low Contact Stress (LCS) prosthesis with mobile meniscal bearings. TKA was performed using fresh frozen human cadaveric knee joints. PCL strain was measured with implantable force transducers. Knee kinematic assessment was made with a load of 300 Newton and without load using a six-degrees-of-freedom testing device. Modification of the tibial slope was analysed radiographically. Statistical analysis was performed using Student's t test, Wilcoxon rank sum test, and the Spearman coefficient of correlation. Results: Assessment of the tibial slope showed a non-significant increase of 2.1° (p = 0.14) following TKA using the NK I, and of 1.1° (p = 0.12) using the LCS, respectively. Analysis of PCL strain following implantation of the NK I prosthesis revealed non-significant alterations both with (p = 0.74) and without load (p = 0.20). Concerning the LCS prosthesis, a significant decrease in PCL strain was seen with load (p = 0.01), whereas non-significant modifications were measured without load (p = 1.0). The modified tibial slope and modified PCL strain following LCS TKA showed no (with load: rs = 0.01) and modest correlation (without load: rs = - 0.43), respectively, whereas it was substantial following NK I TKA (with load: rs = 0.64, without load: rs = 0.70). Conclusion: As the NK I prosthesis allows PCL tension to be close to normal as the knee flexes, it can be stated that regular PCL tension after TKA is restorable and, moreover, it can be hypothesised that the effected tension of the PCL mainly depends on the interaction between design of the implant (fixed/mobile) and the functional role of the PCL.

Schlüsselwörter

Kniegelenkendoprothetik - Knieendoprothese - hinteres Kreuzband - Bandspannung - tibialer Slope

Key words

total knee arthroplasty - total knee replacement - posterior cruciate ligament - ligament strain - tibial slope

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Dr. med. W. Käfer

Orthopädische Universitätsklinik am RKU

Oberer Eselsberg 45

89081 Ulm

Telefon: 07 31/1 77 51 21

Fax: 07 31/1 77 11 03

eMail: wolframkaefer@hotmail.com