Die mediale Gonarthrose

Zusammenfassung

Die Arthrose des Kniegelenks ist mit einer Lebenszeitprävalenz von 23 % bei den über 65-Jährigen eine häufige orthopädische Erkrankung [1]. Aufgrund der demografischen Entwicklung ist mit einer weiteren Zunahme der Anzahl betroffener Patienten zu rechnen. Das mediale Gelenkkompartiment ist dabei aufgrund der Biomechanik und Kinematik des Kniegelenks erheblich häufiger betroffen als das laterale. Erst das Verständnis der funktionellen Anatomie und Pathologie ermöglicht die kritische Wertung der unterschiedlichen zur Verfügung stehenden konservativen und operativen Therapieansätze. Dieser Artikel soll einen Überblick über die diagnostischen und therapeutischen Verfahren der medialen Gonarthrose geben. Dabei sollen insbesondere die medial öffnende tibiale Korrekturosteotomie (HTO), der unikondyläre Gelenkersatz (UNI) und die Totalendoprothese (TEP) als die am häufigsten durchgeführten operativen Maßnahmen vergleichend dargestellt werden. Die aktuelle wissenschaftliche Datenlage wird mit dem Ziel einer evidenzbasierten Diagnostik und einer dem Stadium und der Pathologie angemessenen Therapie der medialen Gonarthrose dargestellt.

Abstract

23 % of all persons older than 65 years suffer from osteoarthritis of the medial compartment of the knee joint, a very common situation in orthopaedic practice [1]. As a result of the demographic trend the number of patients is expected to increase in the future. Based on specific joint biomechanics and kinematics the medial knee joint compartment is more frequently affected than the lateral. Only an understanding of the functional anatomy and underlying pathology allows a critical evaluation of different available conservative and operative treatment options. This article gives an overview of diagnostic and therapeutic strategies of osteoarthritis of the medial knee joint. Frequently performed surgeries, e.g. high tibial osteotomy (HTO), unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) will be presented in a comparative manner. The actual scientific evidence will be given with the goal of an evidence based therapy that is adopted to stage and pathology of osteoarthritis of the medial compartment of the knee joint.

Key words

Gonarthrose - Korrekturosteotomie (HTO) - unikondyläre Endoprothese (UNI) - Totalendoprothese (TEP)

Key words

knee joint arthritis - corrective osteotomy - high tibial osteotomy (HTO) - unicompartmental knee arthroplasty (UKA) - total knee arthroplasty (TKA)

• Literatur

• 1 van Saase JL, van Romunde LK, Cats A et al. Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis 1989; 48: 271-280
• 2 Pinskerova V, Johal P, Nakagawa S et al. Does the femur roll-back with flexion?. J Bone Joint Surg Br 2004; 86: 925-931
• 3 Freeman MA, Pinskerova V. The movement of the normal tibio-femoral joint. J Biomech 2005; 38: 197-208
• 4 Menschik A. Mechanik des Kniegelenks, Teil 2: Schlussrotation. Z Orthop Grenzgeb 1975; 113: 388-400
• 5 Rajendran K. Mechanism of locking at the knee joint. J Anat 1985; 143: 189-194
• 6 Feng Y, Tsai TY, Li JS et al. Motion of the femoral condyles in flexion and extension during a continuous lunge. J Orthop Res 2015; 33: 591-597
• 7 Halder A, Kutzner I, Graichen F et al. Influence of limb alignment on mediolateral loading in total knee replacement: in vivo measurements in five patients. J Bone Joint Surg Am 2012; 94: 1023-1029
• 8 Bergmann G, Bender A, Graichen F et al. Standardized loads acting in knee implants. PLoS ONE 2014; 9: e86035
• 9 Kutzner I, Heinlein B, Graichen F et al. Loading of the knee joint during activities of daily living measured in vivo in five subjects. J Biomech 2010; 43: 2164-2173
• 10 Pandy MG, Andriacchi TP. Muscle and joint function in human locomotion. Annu Rev Biomed Eng 2010; 12: 401-433
• 11 Street BD, Gage W. The effects of an adopted narrow gait on the external adduction moment at the knee joint during level walking: evidence of asymmetry. Hum Mov Sci 2013; 32: 301-313
• 12 Simic M, Hinman RS, Wrigley TV et al. Gait modification strategies for altering medial knee joint load: a systematic review. Arthritis Care Res (Hoboken) 2011; 63: 405-426
• 13 Vincent KR, Conrad BP, Fregly BJ et al. The pathophysiology of osteoarthritis: a mechanical perspective on the knee joint. PM R 2012; 4: S3-S9
• 14 Astephen Wilson JL, Deluzio KJ, Dunbar MJ et al. The association between knee joint biomechanics and neuromuscular control and moderate knee osteoarthritis radiographic and pain severity. Osteoarthritis Cartilage 2011; 19: 186-193
• 15 Jackson BD, Wluka AE, Teichtahl AJ et al. Reviewing knee osteoarthritis–a biomechanical perspective. J Sci Med Sport 2004; 7: 347-357
• 16 Jackson BD, Teichtahl AJ, Morris ME et al. The effect of the knee adduction moment on tibial cartilage volume and bone size in healthy women. Rheumatology (Oxford) 2004; 43: 311-314
• 17 Bundesministerium für Gesundheit. GKV-Statistik KG8 (Krankheitsartenstatistik der gesetzlichen Krankenversicherung) Arbeitsunfähigkeitsfälle und -tage aufgrund von Arthrose; Sonderauswertung (n.d.). 2013.
• 18 Felson DT, Zhang Y, Anthony JM et al. Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. Ann Intern Med 1992; 116: 535-539
• 19 Davis MA, Ettinger WH, Neuhaus JM. Obesity and osteoarthritis of the knee: evidence from the National Health and Nutrition Examination Survey (NHANES I). Semin Arthritis Rheum 1990; 20: 34-41
• 20 Vincent HK, Heywood K, Connelly J et al. Obesity and weight loss in the treatment and prevention of osteoarthritis. PM R 2012; 4: S59-S67
• 21 Tanamas S, Hanna FS, Cicuttini FM et al. Does knee malalignment increase the risk of development and progression of knee osteoarthritis? A systematic review. Arthritis Rheum 2009; 61: 459-467
• 22 Sharma L, Chmiel JS, Almagor O et al. The role of varus and valgus alignment in the initial development of knee cartilage damage by MRI: the MOST study. Ann Rheum Dis 2013; 72: 235-240
• 23 Sharma L, Song J, Felson DT et al. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 2001; 286: 188-195
• 24 Felson DT, Niu J, Yang T et al. Physical activity, alignment and knee osteoarthritis: data from MOST and the OAI. Osteoarthritis Cartilage 2013; 21: 789-795
• 25 Bellemans J, Colyn W, Vandenneucker H et al. The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 2012; 470: 45-53
• 26 Bäthis H, Tingart M, Perlick L et al. Stellenwert von Endoprothetik und Umstellungsosteotomie bei Gonarthrose ± Ergebnisse einer Umfrage an Unfallchirurgischen und Orthopädischen Kliniken. Z Orthop Grenzgeb 2005; 143: 19-24
• 27 Nwachukwu BU, McCormick FM, Schairer WW et al. Unicompartmental knee arthroplasty versus high tibial osteotomy: United States practice patterns for the surgical treatment of unicompartmental arthritis. J Arthroplasty 2014; 29: 1586-1589
• 28 Duncan ST, Khazzam MS, Burnham JM et al. Sensitivity of standing radiographs to detect knee arthritis: a systematic review of level I studies. Arthroscopy 2015; 31: 321-328
• 29 Kellgren JH, Lawrence JS. Radiological assessment of rheumatoid arthritis. Ann Rheum Dis 1957; 16: 485-493
• 30 Duivenvoorden T, van Raaij TM, Horemans HLD et al. Do laterally wedged insoles or valgus braces unload the medial compartment of the knee in patients with osteoarthritis?. Clin Orthop Relat Res 2015; 473: 265-274
• 31 Duivenvoorden T, Brouwer RW, van Raaij TM et al. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database Syst Rev 2015; (3) CD004020
• 32 Bannuru RR, Schmid CH, Kent DM et al. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med 2015; 162: 46-54
• 33 Bellamy N, Campbell J, Robinson V et al. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2006; (2) CD005321
• 34 Bellamy N, Campbell J, Robinson V et al. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2006; (2) CD005328
• 35 Xing D, Yang Y, Ma X et al. Dose intraarticular steroid injection increase the rate of infection in subsequent arthroplasty: grading the evidence through a meta-analysis. J Orthop Surg Res 2014; 9: 107
• 36 Moseley JB, OʼMalley K, Petersen NJ et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002; 347: 81-88
• 37 Laupattarakasem W, Laopaiboon M, Laupattarakasem P et al. Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev 2008; (1) CD005118
• 38 Chaudhry H, Madden K, Bhandari M. Cochrane in CORR. Joint lavage for osteoarthritis of the knee. Clin Orthop Relat Res 2014; 472: 22-27
• 39 Spahn G, Hofmann GO, Klinger HM. The effects of arthroscopic joint debridement in the knee osteoarthritis: results of a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2013; 21: 1553-1561
• 40 Anders S, Schaumburger J, Grifka J. Intraartikuläre operative Maßnahmen bei Arthrose. Orthopäde 2001; 30: 866-880
• 41 Saris DB, Vanlauwe J, Victor J et al. Treatment of symptomatic cartilage defects of the knee: characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture. Am J Sports Med 2009; 37 (Suppl. 01) 10S-19S
• 42 Kreuz PC, Erggelet C, Steinwachs MR et al. Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger?. Arthroscopy 2006; 22: 1180-1186
• 43 Kreuz PC, Steinwachs MR, Erggelet C et al. Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthr Cartil 2006; 14: 1119-1125
• 44 Steadman JR, Briggs KK, Rodrigo JJ et al. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 2003; 19: 477-484
• 45 Harris JD, Brophy RH, Siston RA et al. Treatment of chondral defects in the athleteʼs knee. Arthroscopy 2010; 26: 841-852
• 46 Harris JD, Siston RA, Pan X et al. Autologous chondrocyte implantation: a systematic review. J Bone Joint Surg Am 2010; 92: 2220-2233
• 47 Fu D, Li G, Chen K, Zhao Y et al. Comparison of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of unicompartmental osteoarthritis: a meta-analysis. J Arthroplasty 2013; 28: 759-765
• 48 Brouwer RW, Huizinga MR, Duivenvoorden T et al. Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev 2014; (12) CD004019
• 49 Bonnin M, Chambat P. Der Stellenwert der valgisierenden, zuklappenden Tibiakopfosteotomie bei der medialen Gonarthrose. Orthopäde 2004; 33: 135-142
• 50 Paley D, Herzenberg JE, Tetsworth K et al. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 1994; 25: 425-465
• 51 Savarese E, Bisicchia S, Romeo R et al. Role of high tibial osteotomy in chronic injuries of posterior cruciate ligament and posterolateral corner. J Orthop Traumatol 2011; 12: 1-17
• 52 Voos JE, Suero EM, Citak M et al. Effect of tibial slope on the stability of the anterior cruciate ligament-deficient knee. Knee Surg Sports Traumatol Arthrosc 2012; 20: 1626-1631
• 53 Mancuso F, Hamilton TW, Kumar V et al. Clinical outcome after UKA and HTO in ACL deficiency: a systematic review. Knee Surg Sports Traumatol Arthrosc 2014;
• 54 Boissonneault A, Pandit H, Pegg E et al. No difference in survivorship after unicompartmental knee arthroplasty with or without an intact anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2013; 21: 2480-2486
• 55 Takeuchi R, Umemoto Y, Aratake M et al. A mid term comparison of open wedge high tibial osteotomy vs unicompartmental knee arthroplasty for medial compartment osteoarthritis of the knee. J Orthop Surg Res 2010; 5: 65
• 56 Emerson RH. Unicompartmental mobile-bearing knee arthroplasty. Instr Course Lect 2005; 54: 221-224
• 57 Engh GA, Ammeen D. Is an intact anterior cruciate ligament needed in order to have a well-functioning unicondylar knee replacement?. Clin Orthop Relat Res 2004; (428) 170-173
• 58 Raju PK, Kini SG, Verma A. Wear patterns of tibiofemoral articulation in osteoarthritic knees: analysis and review of literature. Arch Orthop Trauma Surg 2012; 132: 1267-1271
• 59 Van de Velde SK, Gill TJ, Li G. Evaluation of kinematics of anterior cruciate ligament-deficient knees with use of advanced imaging techniques, three-dimensional modeling techniques, and robotics. J Bone Joint Surg Am 2009; 91 (Suppl. 01) 108-114
• 60 Yi S, Tan J, Chen C et al. The use of pneumatic tourniquet in total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 2014; 134: 1469-1476
• 61 Matziolis D, Perka C, Hube R et al. Einfluss der Blutleere auf den perioperativen Blutverlust nach Knietotalendoprothesenimplantation. Orthopäde 2011; 40: 178-182
• 62 Quinn M, Bowe A, Galvin R et al. The use of postoperative suction drainage in total knee arthroplasty: a systematic review. Int Orthop 2015; 39: 653-658
• 63 Zhang QD, Guo WS, Zhang Q et al. Comparison between closed suction drainage and nondrainage in total knee arthroplasty: a meta-analysis. J Arthroplasty 2011; 26: 1265-1272
• 64 Märdian S, Matziolis G, Schwabe P. Influence of wound drainage in primary total knee arthroplasty without tourniquet. Int Orthop 2015; 39: 435-440
• 65 Zhang H, Chen J, Chen F et al. The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2012; 20: 1742-1752
• 66 Zhao-Yu C, Yan G, Wei C et al. Reduced blood loss after intra-articular tranexamic acid injection during total knee arthroplasty: a meta-analysis of the literature. Knee Surg Sports Traumatol Arthrosc 2014; 22: 3181-3190
• 67 Teng Y, Du W, Jiang J et al. Subvastus versus medial parapatellar approach in total knee arthroplasty: meta-analysis. Orthopedics 2012; 35: e1722-e1731
• 68 Liu Z, Yang H. Comparison of the minimally invasive and standard medial parapatellar approaches for total knee arthroplasty: systematic review and meta-analysis. J Int Med Res 2011; 39: 1607-1617
• 69 Li T, Zhuang Q, Xiao K et al. Comparison of the clinical and radiological outcomes following midvastus and medial parapatellar approaches for total knee arthroplasty: a meta-analysis. Chin Med J 2014; 127: 2982-2990
• 70 Amendola A, Bonasia DE. Results of high tibial osteotomy: review of the literature. Int Orthop 2010; 34: 155-160
• 71 Yun XD, Yin XL, Jiang J et al. Local infiltration analgesia versus femoral nerve block in total knee arthroplasty: A meta-analysis. Orthop Traumatol Surg Res 2015;
• 72 Xu J, Chen XM, Ma CK et al. Peripheral nerve blocks for postoperative pain after major knee surgery. Cochrane Database Syst Rev 2014; (12) CD010937
• 73 S3-Leitlinie Prophylaxe der venösen Thromboembolie (VTE). Version vom 18. März 2009. Registrierungsnummer: 003-001.
• 74 Adie S, Kwan A, Naylor JM et al. Cryotherapy following total knee replacement. Cochrane Database Syst Rev 2012; (9) CD007911
• 75 Harvey LA, Brosseau L, Herbert RD. Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database Syst Rev 2014; (2) CD004260
• 76 Schröter S, Ateschrang A, Löwe W et al. Early full weight-bearing versus 6-week partial weight-bearing after open wedge high tibial osteotomy leads to earlier improvement of the clinical results: a prospective, randomised evaluation. Knee Surg Sports Traumatol Arthrosc 2015; [Epub ahead of print]
• 77 Martin R, Birmingham TB, Willits K et al. Adverse event rates and classifications in medial opening wedge high tibial osteotomy. Am J Sports Med 2014; 42: 1118-1126
• 78 Lash NJ, Feller JA, Batty LM et al. Bone grafts and bone substitutes for opening-wedge osteotomies of the knee: a systematic review. Arthroscopy 2015; 31: 720-730
• 79 Staubli AE, De Simoni C, Babst R et al. TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia – early results in 92 cases. Injury 2003; 34 (Suppl. 02) B55-B62
• 80 Valkering KP, van den Bekerom MP, Kappelhoff FM et al. Complications after tomofix medial opening wedge high tibial osteotomy. J Knee Surg 2009; 22: 218-225
• 81 Brosset T, Pasquier G, Migaud H et al. Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFix™) and early weight-bearing: prospective evaluation of bone union, precision and maintenance of correction in 51 cases. Orthop Traumatol Surg Res 2011; 97: 705-711
• 82 Perkins TR, Gunckle W. Unicompartmental knee arthroplasty: 3- to 10-year results in a community hospital setting. J Arthroplasty 2002; 17: 293-297
• 83 Vardi G, Strover AE. Early complications of unicompartmental knee replacement: the Droitwich experience. Knee 2004; 11: 389-394
• 84 Rajasekhar C, Das S, Smith A. Unicompartmental knee arthroplasty. 2- to 12-year results in a community hospital. J Bone Joint Surg Br 2004; 86: 983-985
• 85 Ji JH, Park SE, Song IS et al. Complications of medial unicompartmental knee arthroplasty. Clin Orthop Surg 2014; 6: 365-372
• 86 Vessely MB, Whaley AL, Harmsen WS et al. The Chitranjan Ranawat Award: Long-term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties. Clin Orthop Relat Res 2006; 452: 28-34
• 87 Pulido L, Ghanem E, Joshi A et al. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 2008; 466: 1710-1715
• 88 AQUA Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH. Bundesauswertung zum Erfassungsjahr 2013, 17/5 – Knie-Totalendoprothese-Erstimplantation. 2014.. Im Internet: https://www.sqg.de/downloads/Bundesauswertungen/2013/bu_Gesamt_17N5-KNIE-TEP_2013.pdf Stand: 10.09.2015
• 89 SooHoo NF, Lieberman JR, Ko CY et al. Factors predicting complication rates following total knee replacement. J Bone Joint Surg Am 2006; 88: 480-485
• 90 Sikorski JM, Sikorska JZ. Relative risk of different operations for medial compartment osteoarthritis of the knee. Orthopedics 2011; 34: e847-e854
• 91 Börjesson M, Weidenhielm L, Mattsson E et al. Gait and clinical measurements in patients with knee osteoarthritis after surgery: a prospective 5-year follow-up study. Knee 2005; 12: 121-127
• 92 Ackroyd CE, Whitehouse SL, Newman JH et al. A comparative study of the medial St Georg sled and kinematic total knee arthroplasties. Ten-year survivorship. J Bone Joint Surg Br 2002; 84: 667-672
• 93 Weale AE, Newman JH. Unicompartmental arthroplasty and high tibial osteotomy for osteoarthrosis of the knee. A comparative study with a 12- to 17-year follow-up period. Clin Orthop Relat Res 1994; (302) 134-137
• 94 Hopper GP, Leach WJ. Participation in sporting activities following knee replacement: total versus unicompartmental. Knee Surg Sports Traumatol Arthrosc 2008; 16: 973-979
• 95 Dalury DF, Fisher DA, Adams MJ et al. Unicompartmental knee arthroplasty compares favorably to total knee arthroplasty in the same patient. Orthopedics 2009; 32
• 96 Dalury DF, Mason JB, Murphy JA et al. Analysis of the outcome in male and female patients using a unisex total knee replacement system. J Bone Joint Surg Br 2009; 91: 357-360
• 97 Ritter MA, Wing JT, Berend ME et al. The clinical effect of gender on outcome of total knee arthroplasty. J Arthroplasty 2008; 23: 331-336
• 98 Swedish Knee Arthroplasty Register. Annual report 2014.. Im Internet: http://www.myknee.se/pdf/SKAR2014_Eng_1.1.pdf Stand: 10.09.2015
• 99 Spahn G, Hofmann GO, Engelhardt von LV et al. The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2013; 21: 96-112
• 100 Pearse AJ, Hooper GJ, Rothwell AG et al. Osteotomy and unicompartmental knee arthroplasty converted to total knee arthroplasty: data from the New Zealand Joint Registry. J Arthroplasty 2012; 27: 1827-1831
• 101 McAlindon TE, Bannuru RR, Sullivan MC et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil 2014; 22: 363-388
• 102 Dettoni F, Bonasia DE, Castoldi F et al. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Iowa Orthop J 2010; 30: 131-140