Endoprothetischer Gelenkersatz und Sport

Zusammenfassung

Hintergrund: Es finden sich zunehmend Patienten mit sportlichem Funktionsanspruch, für die nicht nur die Frage nach grundsätzlicher Sportfähigkeit nach Endoprothesenimplantation, sondern auch nach dem erreichbaren Sportniveau im Sinne der Rückkehr zu präoperativer sportlicher Aktivität bedeutsam ist. Dieser Artikel soll einen Überblick über neuere Daten zu folgenden Fragen hinsichtlich Hüft-, Knie und Schulterendoprothetik geben: (1) Welche Auswirkungen hat sportliche Aktivität auf Endoprothesen? (2) Welches Sportniveau ist nach endoprothetischer Versorgung erreichbar? (3) Welche Empfehlungen können zu sportlicher Aktivität mit Endoprothese gegeben werden?

Methoden: PubMed basierte Literaturrecherche. Narrativer Review mit Fokus auf aktuellen Daten aus den Jahren 2010 – 2016.

Ergebnisse: Die allgemein bekannte Empfehlung zu Low-impact-Sportarten mit moderater Intensität wie Wandern, Schwimmen, Radfahren, Golf behält ihre Gültigkeit für sämtliche Prothesentypen an allen Gelenken. Hier ist unstrittig, dass die positiven die negativen Effekte überwiegen. Nach Implantation von HTEP und KTEP findet die Mehrheit der prä-OP aktiven Patienten nach 3 – 6 Monaten wieder zu sportlicher Aktivität zurück, wenn auch mit klarer Tendenz zu niedrigerer Intensität und einer Verschiebung von high impact hin zu low impact. Wichtige offene Fragen beziehen sich auf die Effekte von mit hoher Intensität betriebenen Low-impact-Sportarten, auf High-impact-Sportarten, auf sportartspezifische Wirkungen sowie auf prothesentypspezifische Möglichkeiten. Hier sind die Grenzen zwischen positiven und negativen Effekten von sportlicher Belastung unterschiedlicher Intensität erst beginnend untersucht. Neue Daten weisen darauf hin, dass allgemein eine höhere sportliche Leistungsfähigkeit erreichbar ist, als traditionell empfohlen wird. Frühe Ergebnisse unikondylärer Knieprothesen übertreffen die bikondylärer Prothesen deutlich. Schulterendoprothesen zeigen entgegengesetzt zu Expertenempfehlungen die höchsten postoperativen Aktivitätslevel nach inverser und anatomischer TEP und die geringste Sportaktivität nach Hemiprothesen.

Schlussfolgerung: Bisherige Expertenempfehlungen und faktische Möglichkeiten des Sportniveaus nach Endoprothesenimplantation divergieren zum Teil erheblich. Es bleibt durch zukünftige Studien zu definieren, welches Sportniveau unter Verwendung moderner abriebarmer Gleitpaarungen und Prothesendesigns in welcher Sportart mit welcher Prothese ein positives Nutzen-Risiko-Verhältnis darstellt.

Abstract

Background: An increasing number of physically active patients not only need to know if they will basically be able to engage in sports after undergoing arthroplasty. They also would like to know whether or not they will be able to resume their preoperative activity levels. This article aims to provide an overview of recent data regarding the following questions on hip, knee and shoulder arthroplasty: (1) What is the impact of physical activity on an endoprosthesis? (2) What level of sports can be achieved after an arthroplasty procedure? (3) What types of sport are recommended for patients with an endoprosthesis?

Methods: PubMed-based review of the literature. Narrative review focusing on current data from the years 2010 to 2016.

Results: The commonly known recommendation to exercise low-impact sports such as hiking, swimming, cycling or golf at a moderate intensity remains valid for all types of prostheses in all joints. There is broad consensus that the benefits of these sports outweigh the negative effects. Having undergone total hip or knee arthroplasty, most patients with a high preoperative activity level return to sports after 3-6 months, albeit with a clear tendency to lower intensity and a shift from high-impact to low-impact sports. Some key questions have to be answered regarding the effects of low-impact sports that are exercised with high intensity, the effects resulting from high-impact sports, effects specific to different types of sport, and possibilities provided by different prosthesis types. In this context, a lot remains to be done to investigate the limits between positive and negative effects resulting from physical activity of varying intensity. New data suggests that generally a higher physical performance level may be achieved than has been traditionally recommended. Early results of unicondylar knee prostheses are far better than those achieved with bicondylar prostheses. In contrast to expert recommendations, shoulder endoprostheses show the highest postoperative activity levels after inverted arthroplasty, followed by anatomic arthroplasty, and the lowest activity level after the implantation of a hemiprosthesis.

Conclusion: There is a significant discrepancy between previous expert recommendations and the actual activity levels that may be achieved after the implantation of a joint prosthesis. Future studies have to define the sports level, the type of sports and the type of prosthesis that provide a positive benefit-risk ratio using state-of-the-art low-abrasion bearing surfaces and prosthesis designs.

Schlüsselwörter

Endoprothese - Implantation - Sport

Key words

endoprosthesis - implantation - sport

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