Skip to main content
SpringerLink
Log in

Stellenwert der knienahen Osteotomie bei medialer Gonarthrose

Indikation, Technik und Ergebnisse

Importance of osteotomy around to the knee for medial gonarthritis

Indications, technique and results

  • Leitthema
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Achsenfehlstellungen des Kniegelenks in der Frontalebene erhöhen das Arthroserisiko und bewirken eine rasche Arthroseprogredienz des betroffenen Kompartiments. Bei unilateraler Gonarthrose ist in Abhängigkeit von der metaphysären/konstitionellen Fehlstellung des Kniegelenks die gelenknahe Osteotomie eine Therapiealternative zum Gelenkersatz.

Methoden

Eine exakte Planung anhand einer Ganzbeinaufnahme ist zwingend erforderlich. Die valgisierende Tibiakopfosteotomie kann sicher und atraumatisch als öffnende Osteotomie von medial unter Verwendung eines speziellen Plattenfixateurs durchgeführt werden. Für die distale Femurosteotomie wurde eine neue schließende biplanare Osteotomietechnik unter Verwendung eines anatomisch adaptierten Plattenfixateurs entwickelt.

Bewertung

Eine eigene Nachuntersuchung von 533 Patienten ergab nach 3 bis 5 Jahren hohe Punktwerte im Oxford-Score bei geringer Komplikationsrate. Die subjektiven Bewertungen lagen dabei höher als bei Vergleichsgruppen mit Schlitten- oder Vollprothesen. Aktuelle Metaanalysen zeigen günstige Langzeitergebnisse der knienahen Osteotomie bei Gonarthrose.

Schlussfolgerung

Bei korrekter Indikationsstellung und Operationstechnik kann mit einer valgisierenden Tibiakopfosteotomie ein mittelfristiges funktionelles Ergebnis erzielt werden, welches mindestens gleichwertig zu dem einer Schlittenprothese und besser als jenes einer Vollprothese ist.

Abstract

Background

Frontal plane deformities result in significant overload of the (ipsilateral) affected compartment of the knee and in rapid progression of osteoarthritis. The indication for osteotomy around the knee is related mainly to the constitutional metaphyseal deformity in the frontal plane.

Methods

Exact analysis and planning based on a long-leg standing radiograph is mandatory. Valgus high tibial osteotomy can be performed safely and atraumatically by biplanar open-wedge osteotomy from medial using a specific plate-fixator. A new technique of closed wedge biplanar distal femur osteotomy with fixation by a new plate fixator is also presented.

Results

Our multicenter follow-up study with 533 patients revealed good functional outcome scores with a small complication rate. The subjective ratings were better than in comparable groups with unicondylar knee replacement and with total knee arthroplasty. Metaanalysis from the literature have proven good long-term results of osteotomy around the knee.

Conclusion

Osteotomy around the knee results in good middle-term and long-term results if the indication criteria are respected and a specific surgical technique is used.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Agneskirchner JD, Hurschler C, Stukenborg-Colsman C et al (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 124:575–584

    Article  CAS  PubMed  Google Scholar 

  2. Agneskirchner JD, Hurschler C, Wrann CD et al (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23:852–861

    Article  PubMed  Google Scholar 

  3. Babis GC, An KN, Chao EY et al (2002) Double level osteotomy of the knee: a method to retain joint-line obliquity. Clinical results. J Bone Joint Surg [Am] 84-A:1380–1388

  4. Bellemans J, Colyn W, Vandenneucker H et al (2012) The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 470:45–53

    Article  PubMed Central  PubMed  Google Scholar 

  5. Brinkman JM, Hurschler C, Agneskirchner JD et al (2011) Axial and torsional stability of supracondylar femur osteotomies: biomechanical comparison of the stability of five different plate and osteotomy configurations. Knee Surg Sports Traumatol Arthrosc 19:579–587

    Article  PubMed  Google Scholar 

  6. Brinkman JM, Hurschler C, Staubli AE et al (2011) Axial and torsional stability of an improved single-plane and a new bi-plane osteotomy technique for supracondylar femur osteotomies. Knee Surg Sports Traumatol Arthrosc 19:1090–1098

    Article  PubMed  Google Scholar 

  7. Brinkman JM, Lobenhoffer P, Agneskirchner JD et al (2008) Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg [Br] 90:1548–1557

    Google Scholar 

  8. Brouwer RW, Verhaar JA (2004) Osteotomy at knee level for young patients with gonarthrosis. Ned Tijdschr Geneeskd 148:1955–1960

    CAS  PubMed  Google Scholar 

  9. Floerkemeier S, Staubli AE, Schroeter S et al (2013) Does obesity and nicotine abuse influence the outcome and complication rate after open-wedge high tibial osteotomy? A retrospective evaluation of five hundred and thirty three patients. Int Orthop (im Druck)

  10. Floerkemeier S, Staubli AE, Schroeter S et al (2013) Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 21:170–180

    Article  PubMed  Google Scholar 

  11. Freiling D, Van Heerwaarden R, Staubli A et al (2010) The medial closed-wedge osteotomy of the distal femur for the treatment of unicompartmental lateral osteoarthritis of the knee. Oper Orthop Traumatol 22:317–334

    Article  PubMed  Google Scholar 

  12. Gaasbeek RD, Sonneveld H, Van Heerwaarden RJ et al (2004) Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: a new technique. Knee 11:457–461

    Article  CAS  PubMed  Google Scholar 

  13. Heller MO, Matziolis G, Konig C et al (2007) Musculoskeletal biomechanics of the knee joint. Principles of preoperative planning for osteotomy and joint replacement. Orthopade 36:628–634

    Article  CAS  PubMed  Google Scholar 

  14. Hinterwimmer S, Rosenstiel N, Lenich A et al (2012) Femoral osteotomy for patellofemoral instability. Unfallchirurg 115:410–416

    Article  CAS  PubMed  Google Scholar 

  15. Lobenhoffer P, Agneskirchner J, Zoch W (2004) Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator. Orthopade 33:153–160

    Article  CAS  PubMed  Google Scholar 

  16. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138

    PubMed  Google Scholar 

  17. Lobenhoffer P, Agneskirchner JD, Galla M (2007) Kniegelenknahe Osteotomien Indikation – Planung – Operationstechnik mit Plattenfixateuren. Thieme, Stuttgart

  18. Lobenhoffer P, Heerwaarden RJ van, Staubli AE et al (2008) Osteotomies around the knee. Indications-planning – surgical techniques using plate fixators. Thieme, Stuttgart

  19. Luites JW, Brinkman JM, Wymenga AB et al (2009) Fixation stability of opening- versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. J Bone Joint Surg [Br] 91:1459–1465

    Google Scholar 

  20. Niemeyer P, Koestler W, Kaehny C et al (2008) Two-year results of open-wedge high tibial osteotomy with fixation by medial plate fixator for medial compartment arthritis with varus malalignment of the knee. Arthroscopy 24:796–804

    Article  PubMed  Google Scholar 

  21. Paley D, Pfeil J (2000) Principles of deformity correction around the knee. Orthopade 29:18–38

    CAS  PubMed  Google Scholar 

  22. Schroter S, Lobenhoffer P, Mueller J et al (2012) Changes of patella position after closed and open wedge high tibial osteotomy: review of the literature. Orthopade 41:186, 188–194

    Article  CAS  PubMed  Google Scholar 

  23. Sharma L, Song J, Dunlop D et al (2010) Varus and valgus alignment and incident and progressive knee osteoarthritis. Ann Rheum Dis 69:1940–1945

    Article  PubMed Central  PubMed  Google Scholar 

  24. Sharma L, Song J, Felson DT et al (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286:188–195

    Article  CAS  PubMed  Google Scholar 

  25. Spahn G, Hofmann GO, Von Engelhardt LV et al (2013) The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 21:96–112

    Article  PubMed  Google Scholar 

  26. Staubli AE, De Simoni C, Babst R et al (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia – early results in 92 cases. Injury 34(Suppl 2):B55–B62

    Article  PubMed  Google Scholar 

  27. Takeuchi R, Aratake M, Bito H et al (2009) Clinical results and radiographical evaluation of opening wedge high tibial osteotomy for spontaneous osteonecrosis of the knee. Knee Surg Sports Traumatol Arthrosc 17:361–368

    Article  PubMed  Google Scholar 

  28. Takeuchi R, Saito T, Koshino T (2008) Clinical results of a valgus high tibial osteotomy for the treatment of osteoarthritis of the knee and the ipsilateral ankle. Knee 15:196–200

    Article  PubMed  Google Scholar 

  29. Victor JM, Bassens D, Bellemans J et al (2014) Constitutional varus does not affect joint line orientation in the coronal plane. Clin Orthop Relat Res 472:98–104

    Article  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. P. Lobenhoffer gibt an, dass kein Interessenkonflikt besteht. Soweit der Beitrag personenbezogene Daten enthält, wurde von den Patienten eine zusätzliche Einwilligung nach erfolgter Aufklärung eingeholt. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. SportsClinic Germany, Uhlemeyerstr. 16, 30175, Hannover, Deutschland

    P. Lobenhoffer

Authors
  1. P. Lobenhoffer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Lobenhoffer.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lobenhoffer, P. Stellenwert der knienahen Osteotomie bei medialer Gonarthrose. Orthopäde 43, 425–431 (2014). https://doi.org/10.1007/s00132-013-2189-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-013-2189-7

Schlüsselwörter

Keywords

Search

Navigation