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Aktuelle Rheumatologie 2020; 45(01): 96-105
DOI: 10.1055/a-1036-4100
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Arthroseprävention und mögliche zukünftige Ansätze der Arthrosetherapie – Sicht der Orthopädie und Unfallchirurgie

Prevention of Osteoarthritis and Future Strategies for Osteoarthritis Therapy – an Orthopaedic and Trauma-Surgical Perspective
Lars Rackwitz
1   Klinik für Orthopädie und Unfallchirurgie, Evangelisches Waldkrankenhaus Spandau, Berlin
,
Oliver Pullig
2   Universitätsklinikum Würzburg, Lehrstuhl Tissue Engineering und Regenerative Medizin (TERM), Würzburg
3   Fraunhofer ISC, Translationszentrum Regenerative Therapien (TLZ-RT), Würzburg
,
Ulrich Nöth
1   Klinik für Orthopädie und Unfallchirurgie, Evangelisches Waldkrankenhaus Spandau, Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
07 January 2020 (online)

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Zusammenfassung

Die Arthrose wird heute als eine biomechanische und inflammatorische Organerkrankung angesehen. Biomechanisch stehen die angeborenen und erworbenen präarthrotischen Gelenkerkrankungen im Fokus der Erkrankung. Weiterentwicklungen etablierter operativer Verfahren sowie neue entwickelte Techniken haben insbesondere in der Hüft- und Kniegelenkchirurgie dazu beigetragen dem Patienten bessere präventive Therapieoptionen anbieten zu können. Bezüglich der inflammatorischen Komponente hat sich in der letzten Dekade das Feld der regenerativen Therapien mit neuen therapeutischen Ansätzen entwickelt. Die intraartikuläre Applikation von thrombozytenreichen Plasma, Konzentraten aus Knochenmark-/Fettgewebe und ex vivo expandierten mesenchymalen Stammzellen haben erste viel versprechende Ergebnisse gezeigt. Allerdings fehlen bisher aussagekräftige prospektiv-randomisierte klinische Studien. In dieser Arbeit sollen die neuesten Therapieansätze bzgl. der biomechanischen und inflammatorischen Komponenten der Arthrose aus orthopädisch–unfallchirurgischer Sicht dargestellt und diskutiert werden. Desweitern werden neue Ergebnisse etablierter Behandlungsverfahren, wie die Applikation von Chondroprotektiva und Innovationen in der Endoprothetik beleuchtet.

Abstract

Today, osteoarthritis is considered a biomechanical and inflammatory whole-organ disease. Biomechanically, congenital and acquired pre-osteoarthritic joint diseases are in the focus of interest. Advancements of established surgical methods as well as newly developed techniques, especially in the field of hip and knee joint surgery, have made it possible to offer patients optimised preventive therapeutic strategies. Regarding the inflammatory component, new therapeutic strategies have been developed in the field of regenerative therapies in the last decade. The intraarticular application of platelet-rich plasma, bone marrow/adipose tissue aspirate concentrates and ex-vivo expanded mesenchymal stem cells have shown promising clinical results. However, there is a lack of substantial prospective, randomised clinical trials. This manuscript highlights and discusses the latest therapeutic strategies concerning the biomechanical and inflammatory components of osteoarthritis from an orthopaedic and trauma-surgical perspective. Furthermore, new results of chondroprotective treatment strategies and innovations in arthroplasty are highlighted.

Schlüsselwörter

Arthrose - Präarthrosen - Entzündung - regenerative Therapien - mesenchymale Stammzellen

Key words

osteoarthritis - inflammation - regenerative therapies - mesenchymal stem cells - pre-osteoarthritic conditions
 

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