Endoprothetische Versorgung des Ellenbogengelenkes

Zusammenfassung

Die häufigste Indikation für den Einsatz einer Ellenbogen-Endoprothese stellt die Gelenkzerstörung im Rahmen einer rheumatoiden Arthritis dar, mit Abstand gefolgt von posttraumatischen Gelenkschäden. Erst in jüngerer Zeit werden auch frische Trümmerfrakturen endoprothetisch versorgt. Heutzutage sind praktisch ausschließlich ungekoppelte sowie gekoppelte Prothesen in sloppy-hinge-Konstruktion im Einsatz. Hinsichtlich Schmerzbefreiung, Beweglichkeit und klinischer Gesamtscores sind die Ergebnisse allgemein sehr gut. Dabei schneiden gekoppelte Implantate besser ab als ungekoppelte. Die Komplikationsrate der Ellenbogenendoprothetik ist nach wie vor hoch. In einer eigenen Serie wurden im Zeitraum von 1987–2005 an 177 Patienten (R.A. 165, PsA. 4, Arthrose 8) 195 Ellenbogenprothesen implantiert (GSB III 116, Coonrad-Morrey 46, Souter-Strathclyde 24, Link-Scharnier 4, Custom-made 4, Pritchard 1). Es fand sich analog zu den Literaturangaben eine hohe Komplikationsrate von 34,4%. An 53 Ellenbögen (27,2%) war eine Gesamtzahl von 89 Revisionen erforderlich. Häufigste und schwerwiegendste Komplikation waren tiefe Infektionen, die in 21 Fällen (10,6%) beobachtet wurden, davon nur ein Drittel als Frühinfekt, die übrigen zwei Drittel im Mittel nach 5,5 Jahren. Die höchste Lockerungsrate wies die Souter-Prothese auf. Trotz guter klinischer Ergebnisse sollte die Indikation zum endoprothetischen Ersatz des Ellenbogengelenkes streng gestellt werden.

Abstract

Rheumatoid arthritis represents the main indication for total elbow arthroplasty. Nowadays unlinked prostheses and linked implants with a sloppy hinge mechanism are used almost exclusively. Clinical results in terms of pain reduction, mobility and total scores are generally excellent with better performance of the linked compared to the unlinked prostheses. The complication rate in elbow arthroplasty remains high. Between 1987 and 2005 a total of 195 elbow prostheses was implanted (GSB III 116, Coonrad-Morrey 46, Souter-Strathclyde 24, link hinge 4, custom-made 4, Pritchard 1). The complication rate was 34.4%. 89 revision procedures for different reasons were performed in 53 elbows (27.2%). Deep infection occurred in 21 cases (10.2%), from which only one third developed early. The survival of the semi-constrained GSB III and Coonrad-Morrey implants was superior to that of the Souter implant. Because total elbow replacement is associated with a high complication rate, a careful selection of patients for this procedure is warranted.

Schlüsselwörter

rheumatoide Arthritis - Ellenbogen-Endoprothese - Komplikationen

Key words

rheumatoid arthritis - total elbow replacement - complications

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