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DOI: 10.1055/s-0030-1250690
© Georg Thieme Verlag KG Stuttgart · New York
Ergebnisse einzeitiger vs. zweizeitiger bilateraler Knietotalendoprothetik
Results of Single Stage vs. Two-Stage Total Knee ArthroplastyPublication History
Publication Date:
26 January 2011 (online)
Zusammenfassung
Hintergrund: Die endoprothetische Versorgung arthrotischer Kniegelenke ist eine erfolgreiche Operationsmethode. Bei bilateralem Befall der Kniegelenke ist bis heute umstritten, ob eine einzeitig bilaterale Versorgung einer zweizeitigen Versorgung vorzuziehen ist und in welchem zeitlichen Abstand diese Operationen erfolgen sollten. Ziel der vorliegenden Arbeit war es, die klinischen und radiologischen Ergebnisse nach bilateral einzeitiger und bilateral zweizeitiger Implantation von Knietotalendoprothesen vergleichend zu betrachten und einen Vergleich der Ergebnisse in Abhängigkeit des zeitlichen Abstands bei zweizeitigem Vorgehen durchzuführen. Material und Methoden: In diese retrospektive Nachuntersuchung konnten 43 Patienten mit bilateral einzeitigem Kniegelenksersatz sowie 35 Patienten mit bilateral zweizeitigem Kniegelenksersatz mit maximalem Abstand der Operationen von 12 Monaten eingeschlossen werden. Der Nachuntersuchungszeitraum betrug im Mittel 31 ± 15 Monate. Die klinisch-funktionelle Beurteilung der Kniegelenke erfolgte mittels Knee-Society-Score und Stolzalpen-Knee-Score. Die subjektive Lebensqualität wurde mithilfe des SF-36 ermittelt. Das subjektive Schmerzempfinden wurde anhand der visuellen Analogskala gemessen. Die radiologische Beurteilung erfolgte unter Anwendung des Knee-Society-Roentgenographic-Evaluation-and-Scoring-Systems. Ergebnisse: Die Auswertung der klinisch-funktionellen Ergebnisse zeigte einen verbesserten Bewegungsumfang der Kniegelenke bei zweizeitigem Vorgehen mit einem OP-Abstand von 4–6 Monaten und geringere Punktwerte für die Patienten mit 10 bis 12 Monaten OP-Abstand. Radiologisch ließen sich keine Unterschiede bei der Implantatpositionierung nachweisen. In der bilateral einzeitigen Gruppe war die Komplikationsrate signifikant erhöht. Die Patienten der bilateral zweizeitigen Gruppe waren annähernd doppelt so lang hospitalisiert wie die bilateral einzeitig operierten Patienten. Schlussfolgerungen: Die Auswertung der klinischen und radiologischen Ergebnisse zeigte nur marginale Unterschiede zwischen den beiden Gruppen. Die funktionellen Ergebnisse sind bei zweizeitiger Versorgung in einem Abstand von 4–6 Monaten am besten. Es zeigte sich jedoch eine signifikant erhöhte Komplikationsrate der einzeitig bilateral versorgten Patientengruppe. Die Entscheidung zur ein- bzw. zweizeitigen Versorgung bei vorliegender bilateraler Gonarthrose ist immer unter Berücksichtigung der individuellen Situation im Konsens zwischen Operateur und Patient zu treffen.
Abstract
Background: The total knee arthroplasty (TKA) is a successful procedure. In cases of bilateral knee osteoarthritis, advantages of single stage TKA vs. two-stage TKA as well as the gap between the procedures in case of two-stage TKA are discussed controversially. The aim of the present study is to compare the clinical and radiographic results of single stage bilateral TKA and two-stage bilateral TKA. In cases of two-stage TKA the dependency on the gap between surgeries was determined. Material and Methods: In this retrospective study 43 patients with single stage TKA and 35 patients after two-stage TKA with a maximum of 12 months between surgeries were included. Follow-up was in mean 31 ± 15 months. For clinical and radiological evaluation the Knee Society score (KSS) and Stolzalpen knee score were used. Quality of life was measured by the SF-36 score. The pain was determined using a visual analogue scale (VAS). Radiological evaluation was done by use of Knee Society roentgenographic evaluation and scoring system. Results: The overall hospital stay for patients with two-stage TKA (26 ± 5 days) was twice as long as for patients with single stage TKA (14 ± 4 days). Patients with single stage bilateral TKA had a significantly higher KSS level (186 ± 19 points) than patients after two-stage bilateral TKA (179 ± 22 points). Within the two-stage group the best range of motion was achieved by patients with a gap of 4 to 6 months between surgeries and a decreased point value was measured in patients with a gap of 10 to 12 months between TKAs. Using the VAS patients with simultaneous bilateral TKA had significantly increased pain levels during passive motion. Within the two-stage group there were no differences in VAS. The results of Stolzalpen knee score were comparable in both groups. The analysis of radiological measurements showed a significantly higher number of radiolucent lines (1 mm) in patients with single stage TKA without any clinical relevance or progress in follow-up. Patients with single stage bilateral TKA had a higher complication rate than patients with a two-stage procedure. In the single stage group 6 patients had to be revised because of fracture, dislocation, peroneal nerve palsy, patella lateralisation or loosening. In the two-stage group only one patient had to be revised due to a quadriceps tendon rupture caused by a fall at day one after surgery. Conclusion: Analysis of clinical and radiological results shows only marginal differences between the two groups. In two-stage procedures functional results were best when the second surgery was done 4 to 6 months after the first procedure. Single stage TKA had a significantly higher complication rate. However, patient and surgeon should make the decision for single or two-stage bilateral TKA individually.
Schlüsselwörter
bilaterale Knieendoprothese - einzeitig - zweizeitig
Key words
bilateral TKA - single stage TKA - two‐stage TKA
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PD Dr. med. David Wohlrab
Klinik und Poliklinik für Orthopädie und Physikalische Medizin
Universitätsklinikum Halle (Saale)
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Phone: 03 45/5 57 48 05
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Email: david.wohlrab@medizin.uni-halle.de