Beckmann J, Hirschmann M T, Matziolis G, Holz J, V Eisenhart-Rothe R, Becher C
Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland.
Kantonsspital Baselland, Liestal, Schweiz.
Orthopade. 2021 Feb;50(2):104-111. doi: 10.1007/s00132-020-04054-9.
A higher patient satisfaction stands in contrast to higher revision rates of unicondylar knee joint endoprosthetics (UKE) compared to total knee joint endoprosthetics (TKE). Furthermore, old "dogmas" regarding indications and contraindications persist, which is still reflected in the significantly different case numbers.
The aim of this article is to provide an overview of the current literature regarding 1. indication and contraindication (BMI, age, sport, arthrosis of other compartments, ligament status) and 2. the "eternal rival" fixed or mobile bearing for UKE.
The choice of the right patient remains essential, even if all the old "dogmas" of contraindications have been relativized or even outdated. Arthroses of the contralateral (in medial UKE correspondingly lateral) compartment and advanced arthroses of the lateral patella facet remain the only persistent contraindications. In contrast, a high BMI, age, chondrocalcinosis, medial patella facet and a defective (but particularly functionally stable) ACL are not contraindications; however, severe obesity is responsible for a significantly higher complication rate and probably a higher rate of loosening. Rather, the experience and thus the number of UKEs of the individual surgeon is decisive for the outcome, to which the discussion about mobile or fixed inlays must also be completely subordinated.
The indications for UKE can, therefore, be extended with a clear conscience on the basis of literature, and the current 1:10 UKE:TKE ratio in Germany can be shifted significantly.
与全膝关节置换术（TKE）相比，单髁膝关节置换术（UKE）患者满意度较高，但翻修率也较高。此外，关于适应症和禁忌症的旧“教条”仍然存在，这在病例数量的显著差异中仍有体现。
本文旨在概述当前关于1. 适应症和禁忌症（体重指数、年龄、运动、其他关节间室关节炎、韧带状态）以及2. UKE的“永恒对手”——固定或活动衬垫的文献。
即使所有旧的禁忌症“教条”已被相对化甚至过时，选择合适的患者仍然至关重要。对侧（内侧UKE对应的外侧）关节间室的关节炎和外侧髌骨关节面的晚期关节炎仍然是唯一持续存在的禁忌症。相比之下，高体重指数、年龄、软骨钙质沉着症、内侧髌骨关节面和有缺陷（但功能特别稳定）的前交叉韧带不是禁忌症；然而，严重肥胖会导致显著更高的并发症发生率，可能还有更高的松动率。相反，个体外科医生的经验以及UKE的数量对结果起决定性作用，关于活动或固定镶嵌物的讨论也必须完全服从于此。
因此，基于文献可以放心地扩大UKE的适应症，德国目前1:10的UKE与TKE比例可能会显著改变。
