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OP-Journal 2015; 31(01): 37-44
DOI: 10.1055/s-0035-1545838
Georg Thieme Verlag KG Stuttgart · New York

Kniegelenksnahe Frakturen bei Knie-TEP

Periprosthetic Fractures around the Knee
Karl-Heinz Frosch
,
Jürgen Madert
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Publication History

Publication Date:
05 August 2015 (online)

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Zusammenfassung

Durch die zunehmende Endoprothetisierung der Bevölkerung nimmt auch die Anzahl an periprothetischen Frakturen insbesondere des Kniegelenks zu. Ca. 95 % aller periprothetischen Frakturen betreffen das distale Femur, etwa 4 % die proximale Tibia. Hauptrisikofaktoren, eine periprothetische Fraktur nach Knieendoprothese zu erleiden, sind aktive Patienten unter 60 Jahren, stattgehabter Endoprothesenwechsel, Osteoporose und, sofern es die periprothetischen Frakturen der Patella betrifft, ein femorales Overstuffing, ein verkürztes Lig. patellae und die Durchführung eines Lateral Releases. Am Femur haben sich als Osteosyntheseverfahren die winkelstabile Plattenosteosynthese oder auch der retrograde Marknagel, welcher biomechanische Vorteile besitzt, durchgesetzt. Drahtcerclagen können die mechanische Stabilität der Osteosynthese erhöhen. Bei gelockerten Implantaten ist i. d. R. der Wechsel auf ein Revisionsimplantat notwendig. Zu beachten ist, dass nach aktueller Studienlage die meisten periprothetischen Frakturen der Tibia mit einem gelockerten Implantat einhergehen, femoral sind die Komponenten meist fest integriert. Periprothetische Frakturen der Patella können zu erheblichen Problemen mit verzögerter Heilung aufgrund der meist problematischen Blutversorgung führen, was bereits bei der Primärimplantation zu berücksichtigen ist. Aufgrund hoher Komplikationsraten von periprothetischen Frakturen am Kniegelenk, die zwischen 12 und 41 % angegeben werden, ist eine optimale Versorgung essenziell.

Abstract

With the increasing number of arthroplasties being performed, an elevated incidence of periprosthetic fractures around the knee can be observed. About 95 % of the fractures are located at the distal femur, 4 % are found at the tibia and 1 % at the patella. The main risk factors to suffer from a periprosthetic fracture around the knee are high activity levels combined with an age lower than 60 years, revisionarthroplasty, long stems and osteoporosis. Femoral overstuffing, patella baja and lateral release are risk factors for patella fractures. At the femoral location, angle stable plates or a retrograde nail are the prefered implants. Cerclage wires enhance the biomechanical stability. Loose implants result in the necessity to perform a revision arthroplasty. According to the current literature, most periprosthetic fractures at the tibial side are accompanied with a loose implant, at the femoral side the implants are stably integrated in most cases. Periprosthetic patella fractures often have healing problems due to an impaired blood supply after an anteromedial arthrotomy. In general there is a high complication rate of 12 to 41 % in the treatment of periprosthetic fractures around the knee. This should be considered for the primary knee arthroplasty as well as in the treatment of the periprosthetic fractures.

 

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