Zusammenfassung
Operationsziel
Minimalinvasiver Zugang zum Kniegelenk zur Implantation von Kniegelenkendoprothesen in der Absicht, die Weichteiltraumatisierung zu vermindern.
Indikationen
Implantation von Knieendoprothesen.
Revisionseingriffe nach Alloarthroplastik.
Kontraindikationen
Hochgradige Adipositas.
Revisionseingriffe mit präoperativer Beweglichkeit < 90°.
Operationstechnik
Anteromedialer Längsschnitt über der Vorderseite des Kniegelenks. Stumpfes Auseinanderdrängen der distalen, schräg verlaufenden Muskelfasern des Musculus vastus medialis auf einer Länge von 1–3 cm bis zum medialen proximalen Patellapol. Fortsetzen der Inzision medial parapatellar bis zur Tuberositas tibiae. Nach Eröffnung des Gelenks wird die Patella nach lateral verschoben, ohne sie zu evertieren. Darstellen der Gelenkflächen. Die Operation erfolgt in maximaler Beugung des Kniegelenks von 90°. Nach Prothesenimplantation schichtweiser Wundverschluss; dabei nur oberflächliche Adaptation der Muskelfasern des Musculus vastus medialis.
Weiterbehandlung
Mobilisierung mit schmerzorientierter Vollbelastung der operierten Extremität und Freigabe der Beweglichkeit.
Ergebnisse
In einer prospektiven Studie wurden zwischen 2005 und 2007 267 Knieendoprothesen über den Mini-Midvastus-Zugang implantiert. Alle Patienten (160 Frauen, 107 Männer in einem Durchschnittsalter von 69,3 Jahren [46–89 Jahre]) wurden präoperativ und 6 Wochen postoperativ klinisch und radiologisch untersucht. Bei der klinischen Untersuchung wurde der funktionelle Score der American Knee Society verwendet. Der präoperative Wert von durchschnittlich 48,9 (32–68) konnte nach 6 Wochen auf 86,5 (75–100) gesteigert werden. Radiologisch ließ sich bei 92,1% ein Implantationsfehler < 3° nachweisen.
Abstract
Objective
Minimally invasive approach to the knee for total knee arthroplasty to reduce soft-tissue trauma.
Indications
Total knee replacements.
Revision surgery after total knee arthroplasty.
Contraindications
Severe obesity.
Revision surgery with preoperative flexion < 90°.
Surgical Technique
Anterior midline incision, blunt separation of the distal part of the oblique fibers of the vastus medialis over a length of 1–3 cm. The muscle split ends at the proximal medial corner of the patella. The incision is continued medially of the patella ending at the tibial tuberosity. After approaching the joint, the patella is shifted laterally without dislocating it, thus exposing the articular surfaces. Surgery is performed in maximal knee flexion of 90°. After insertion of the components, stepwise wound closure and only superficial adaptation of the muscle split.
Postoperative Management
Mobilization with weight bearing and range of motion as tolerated.
Results
In a prospective study, 267 knee prostheses were implanted between 2005 and 2007 using the mini-midvastus approach. All patients (160 female, 107 male, average age 69.3 years [46–89 years]) were examined clinically and radiologically prior to and 6 weeks after surgery. The clinical results were based on the American Knee Society Score, which increased from a preoperative value of 48.9 (32–68) to 86.5 (75–100) at follow-up. Radiologically, 92.1% of the knees showed a malposition < 3°.
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Literatur
Akagi M, Matsusue Y, Mata T, et al. Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop 1999;366:155–163.
Bäthis H, Perlick L, Blum C, et al. Midvastus approach in total knee arthroplasty: a randomized, double-blind study on early rehabilitation. Knee Surg Sports Traumatol Arthrosc 2005;13:545–550.
Boyd AD Jr, Ewald FC, Thomas WH, et al. Long term complications after total knee arthroplasty with or without resurfacing of the patella. J Bone Joint Surg Am 1993;75:674–681.
Cooper RE Jr, Trinidad G, Buck WR. Midvastus approach in total knee arthroplasty: a cadaveric study determining the distance of the popliteal artery from the patellar margin of the incision. J Arthroplasty 1999;14:505–508.
Dalury DF, Jiranek WA. A comparison of the midvastus and paramedian approaches for total knee arthroplasty. J Arthroplasty 1999;14:33–37.
Dalury DF, Snow RG, Adams MJ. Electromyographic evaluation of the midvastus approach. J Arthroplasty 2008;23:136–140.
Engh GA, Holt BT, Parks NL. A midvastus muscle splitting approach for total knee arthroplasty. J Arthroplasty 1997;12:322–331.
Engh GA, Parks NL. Surgical technique of the midvastus arthrotomy. Clin Orthop 1998;351:270–274.
Engh GA, Parks NL, Ammeen DJ. Influence of surgical approach on lateral retinacular releases in total knee arthroplasty. Clin Orthop 1996;331:56–63.
Flören M, Davis J, Peterson MG, et al. A mini-midvastus capsular approach with patellar displacement decreases the prevalence of patella baja. J Arthroplasty 2007;22:51–57.
Haas SB, Cook S, Beksac B. Minimally invasive total knee replacement through a mini midvastus approach: a comparative study. Clin Orthop 2004;428:68–73.
Haas SB, Manitta MA, Burdick P. Minimally invasive total knee arthroplasty: the mini midvastus approach. Clin Orthop 2006;452:112–116.
Hube R, Sotereanos NG, Reichel H. The midvastus approach for total knee arthroplasty. Oper Orthop Traumatol 2002;3:253–263.
Kelly MJ. Patellofemoral complications following total knee arthroplasty. Instr Course Lect 2001;50:403–407.
Kelly MJ, Rumi MN, Kothari M, et al. Comparison of the vastus-splitting and median parapatellar approaches for primary total knee arthroplasty: a prospective, randomized study. J Bone Joint Surg Am 2006;88:715–720.
Kelly MJ, Rumi MN, Kothari M, et al. Comparison of the vastus-splitting and median parapatellar approaches for primary total knee arthroplasty: a prospective, randomized study. Surgical technique. J Bone Joint Surg Am 2007;89:80–92.
Larson CM, Lachiewicz PF. Patellofemoral complications with the Insall Burstein II posterior-stabilized total knee arthroplasty. J Arthroplasty 1999;14:288–292.
Laskin RS. Minimally invasive total knee arthroplasty: the results justify its use. Clin Orthop 2005;440:54–59.
Laskin RS. Surgical exposure for total knee arthroplasty: for everything there is a season. J Arthroplasty 2007;22:12–14.
Laskin RS, Beksac B, Phongjunakorn A, et al. Minimally invasive total knee replacement through a mini-midvastus incision: an outcome study. Clin Orthop 2004;428:74–81.
Laskin RS, van Steeijn M. Total knee replacement for patients with patellofemoral arthritis. Clin Orthop 1999;367:89–95.
Laughlin RT, Werries BA, Verhulst SJ, et al. Patellar tilt in total knee arthroplasty. Am J Orthop 1996;25:300–304.
Lonner JH. Minimally invasive approaches to total knee arthroplasty: results. Am J Orthop 2006;35:27–29.
Nelissen RG, Weidenheim L, Mikhail WE. The influence of the position of the patellar component on tracking in total knee arthroplasty. Int Orthop 1995;19:224–228.
Ohnsorge JA, Laskin RS. Special surgical technique of minimally invasive total knee replacement. Z Orthop Ihre Grenzgeb 2006;144:91–96.
Pietsch M, Djahani O, Hofmann S. Minimally invasive mini-midvastus approach as standard in total knee arthroplasty. Orthopäde 2007;36:1120–1128.
Repicci JA, Eberle RW. Minimally invasive surgical technique for unicondylar knee arthroplasty. J South Orthop Assoc 1999;8:20–27.
Ritter MA, Pierce MJ, Zhou H, et al. Patellar complications (total knee arthroplasty). Effect of lateral release and thickness. Clin Orthop 1999;367:149–157.
Romanowski MR, Repicci JA. Minimally invasive unicondylar arthroplasty, eight year follow-up. J Knee Surg 2002;15:17–22.
Scuderi GR, Insall JN, Scott NW. Patellofemoral pain after total knee arthroplasty. J Am Acad Orthop Surg 1994;2:239–246.
Tria AJ Jr. Minimally invasive total knee arthroplasty: the importance of instrumentation. Orthop Clin North Am 2004;35:227–234.
Walter F, Haynes MB, Markel DC. A randomized prospective study evaluating the effect of patellar eversion on the early functional outcomes in primary total knee arthroplasty. J Arthroplasty 2007;22:509–514.
White RE Jr, Allman JK, Trauger JA, et al. Clinical comparison of the midvastus and medial parapatellar surgical approaches. Clin Orthop 1999;367:117–122.
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Hube, R., Keim, M. & Mayr, H.O. Der Mini-Midvastus-Zugang zur Implantation von Kniegelenkendoprothesen. Orthop Traumatol 21, 3–13 (2009). https://doi.org/10.1007/s00064-009-1601-2
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DOI: https://doi.org/10.1007/s00064-009-1601-2
Schlüsselwörter
- Zugang bei Knieendoprothese
- Midvastus-Zugang
- Minimalinvasive Kniegelenkendoprothetik
- Frühfunktionelle Ergebnisse