Meier Malin, Calliess Tilman, Tibesku Carsten, Beckmann Johannes
Universitätsklinik für Orthopädische Chirurgie und Traumatologie, Inselspital, Bern, Schweiz.
articon Spezialpraxis für Gelenkchirurgie, Bern, Schweiz.
Orthopade. 2021 Feb;50(2):130-135. doi: 10.1007/s00132-020-04058-5.
Unicondylar knee arthroplasty offers the advantage that partial degenerative changes can be addressed with partial prosthetic solutions, thus preserving as much of the native joint as possible, including the cruciate ligaments. On the other hand, the number of revisions is still higher than for total knee endoprosthetics. In the literature, the causes mentioned are insufficient fit of the components as well as surgical errors. The use of new technologies to achieve a better fit and higher surgical precision and reproducibility, therefore, represents a promising approach.
Individual endoprosthetics offers the advantage that the prosthesis is adapted to the individual anatomy of each patient and not the patient's anatomy to the prosthesis, as is the case with standard prostheses. This allows for an optimal fit of the prosthesis while avoiding excessive bone resections and soft tissue releases.
The use of robotics in endoprosthetics makes it easier to correctly perform bone resections and align components. This ensures high and reproducible precision even for surgeons with lower case numbers. Studies on individual unicondylar endoprosthetics and robotics are reporting promising results. However, long-term results of high-quality randomized studies must be awaited in order to make a scientifically sound statement.
单髁膝关节置换术的优势在于,部分退行性改变可通过部分假体解决方案来解决,从而尽可能多地保留天然关节,包括交叉韧带。另一方面,其翻修次数仍高于全膝关节假体。文献中提到的原因包括组件贴合不佳以及手术失误。因此,采用新技术以实现更好的贴合度、更高的手术精度和可重复性是一种很有前景的方法。
个性化假体的优势在于,假体是根据每位患者的个体解剖结构定制的,而不像标准假体那样是让患者的解剖结构去适应假体。这使得假体能够实现最佳贴合,同时避免过度的骨切除和软组织松解。
在假体植入中使用机器人技术能更轻松地正确进行骨切除和组件对齐。即使对于手术量较少的外科医生,这也能确保高精度且可重复。关于个性化单髁假体和机器人技术的研究报告了令人鼓舞的结果。然而,必须等待高质量随机研究的长期结果,才能做出科学合理的论断。