Knieprothesendesign und Kinematik: Unterschiede in Radien, Konformität und Rotation/Pivot

Zusammenfassung

Mittlerweile findet sich ein schier unendliches Angebot an Knieprothesenmodellen auf dem Markt, aus denen der Chirurg für seine Versorgung wählen kann. Obwohl sich die Designs auf den ersten Blick immer weiter annähern und ähneln, betreibt die Industrie einen hohen Aufwand, unterschiedliche Designmerkmale als Alleinstellung herauszuarbeiten. Für den Anwender ist es zunehmend schwierig, den Überblick zu behalten und die tatsächliche Relevanz der Features zu bewerten. Unabhängige vergleichende wissenschaftliche Arbeiten sind Mangelware und die Evidenz entsprechend gering. Dennoch erfordern unterschiedliche Designphilosophien ein tiefgründiges konzeptionelles Verständnis und besondere Operationsalgorithmen, sodass sich der Chirurg mit der von ihm benutzten Prothese entsprechend gut auskennen muss. Interessant ist auch eine sich aus diesem Wissen ergebende indikationsbezogene Prothesenauswahl. Im Folgenden wird ein kurzer Überblick über die wesentlichen Konzepte der ungekoppelten Primärprothesen gegeben und deren klinisch relevante Unterschiede in Bezug auf die Biomechanik und den klinischen Einsatz angesprochen.

Abstract

Today, there is an almost endless variety of knee prosthesis models on the market from which the surgeon can choose. Although the designs appear closer and closer to one another, the industry makes a great effort to emphasise different features as beneficial and a stand-alone. It is increasingly difficult to keep an overview and to assess the clinical relevance of the diverse features. There is a clear lack of independent comparative studies and evidence is low. Nevertheless, different design philosophies require special surgical techniques, so that the surgeon must be familiar with the peculiarity of his/her prosthesis. Also, a differentiated indication for different designs appears to be an interesting concept. The aim of this essay is to give a brief overview of the major design concepts of current unconstrained knee prosthesis designs and their differences regarding biomechanics and kinematics.

Schlüsselwörter

Knieprothesendesign - Biomechanik - Kinematik - Radien - Konformität

Key words

total knee arthroplasty - prosthetic design features - biomechanics - radii - conformity

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