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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