https://doi.org/10.17192/z2018.0194 Medium-term results of the total knee endoprosthesis type Foundation Medizin 2018-03-29 2018 Publikationsserver der Universitätsbibliothek Marburg Universitätsbibliothek Marburg Medizin ths Prof. Dr. med. Kienapfel Heino Kienapfel, Heino (Prof. Dr. med.) doctoralThesis Philipps-Universität Marburg mittelfristige Ergebnisse Mittelfristige Ergebnisse der Knietotalendoprothese Typ Foundation Gesundheit 116 application/pdf total knee endoprosthesis Im Zeitraum von Mai 1993 bis Dezember 1995 wurden in der orthopädischen Abteilung der St. Vincentius-Krankenhäuser in Karlsruhe 263 Prothesen bei 249 Patienten implantiert. Zwischen Ende Oktober 1996 und Ende Dezember 1998 konnten 127 Patienten mit 143 implantierten Prothesen nachuntersucht werden. Die Indikationsstellung betraf bei 126 Patienten eine primäre Gonarthrose und bei 17 Patienten eine Rheumatoide Arthritis, posttraumatische Arthrose oder ein notwendiger Prothesenwechsel. Die Auswertung der prä- und postoperativen Daten erfolgte mit dem HSS-Score und dem KS-Score, der unterteilt wurde in den klinischen Score und den Function-Score. Hierzu wurde ein eigener Fragebogen entwickelt, der beide Scores beinhaltete. Zusätzlich erfolgte die gesonderte Betrachtung der Patienten mit primärer Gonarthrose von denen der Gruppe mit einer rheumatoiden Arthritis, stattgehabten kniegelenksnahen Frakturen, sowie Patienten mit Prothesenwechseln. Beim HSS-Score zeigten sich bei insgesamt 109 Patienten bzw. Prothesen (77%) postoperativ sehr gute Gesamtergebnisse. Unterscheidet man beide Gruppen findet sich eine deutliche Differenz (GA 77% - RA et. Al. 70,6%). Bei dem klinischen KS-Score wiesen sogar 118 Patienten (82%) exzellente und weitere 15 (10%) gute Ergebnisse auf. Mehr als 75 % der Patienten wiesen bezüglich des Kniegelenkes absolute Schmerzfreiheit auf. Der Function-Score, der ohne den Einfluss von subjektiven Kriterien auskommt, zeigte ebenfalls in beiden Subpopulationen vergleichbar gute bis exzellente Ergebnisse (101 (80%) Patienten aus der Gruppe der GA und 13 (77%) aus der anderen Gruppe). Insgesamt sind die Ergebnisse im Function-Score in beiden Gruppen besser als im Knee-Score. Der Knee-Score zeigte größere Differenzen zwischen beiden Gruppen. Im Rahmen der radiologischen Nachuntersuchungen fanden sich, bis auf einen Fall von Patellaversagen, bei keinem der Prothesen mögliche oder eindeutige Lockerungszeichen. Die Bestimmung der Beinachse brachte von den Ergebnissen her die größten Diskrepanzen zwischen den beiden Scores hervor. Hier zeigt sich eine Schwäche des HSS-Scores, der die physiologische Beinachse nicht definiert. Trotzdem ist die Erhebung der Achsenfehlstellung präoperativ eines der wichtigsten Kriterien für die Indikationsstellung zur Implantation einer ungekoppelten Knietotalendoprothese. Zusammenfassend betrachtet zeigen sich mittelfristig in beiden Gruppen signifikante Verbesserungen in beiden Scores verbunden mit einer deutlichen Zunahme der Lebensqualität. Die ungekoppelte Knietotalendoprothese Typ Foundation weist sehr gute funktionelle und stabilisierende Eigenschaften auf. Sie kommt somit den Anforderungen, die an die physiologische Biomechanik eines Kniegelenkes gestellt werden sehr nahe. Die knochensparende Implantationstechnik lässt, abhängig vom Patienten und der Indikationsstellung, selbst bei einem später notwendigen Prothesenwechsel noch die erneute Implantation eines Oberflächengleitersatzes, ggf. auch kreuzbandresezierend, zu. Orthopädie und Rheumatologie 2018-03-29 Jänig, Carola Jänig Carola urn:nbn:de:hebis:04-z2018-01948 German Medical sciences Medicine Medizin Kienapfel H, Griss P, Orth J, Roloff K, + Malzer U. (Juni 1991). 2-5 -Year follow-up of cementless implantable knee joint prosthesis of the Miller-Galante Type. 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In Am J Orth Surg (pp. 30-33). medium-term-results https://archiv.ub.uni-marburg.de/diss/z2018/0194/cover.png Knietotalendoprothese In the period from May 1993 to December 1995, 263 prostheses were implanted in 249 patients in the orthopedic department of St. Vincentius hospitals in Karlsruhe. Between the end of October 1996 and the end of December 1998 127 patients with 143 implanted prostheses were examined. For 126 patients, the indications were primary gonarthrosis and for 17 patients rheumatoid arthritis, posttraumatic osteoarthritis or a necessary prosthesis change. The pre- and postoperative data were evaluated with the help of the HSS score and the KS score, which were divided into the clinical score and the function score. For this purpose, a separate questionnaire was developed, that included both scores. In addition, patients with primary gonarthrosis were considered separately from those with rheumatoid arthritis, fractures close to the knee joint, and patients with prosthesis changes. The HSS score showed postoperatively very good overall results for a total of 109 patients or prostheses (77%). The difference between the two groups is significant (GA 77% - RA et al., 70.6%). In the clinical KS score, even 118 patients (82%) had excellent and another 15 (10%) good results. More than 75% of the patients in both groups had absolute pain relief with regard to the knee joint. The functional score, that is not influenced by subjective criteria, also showed comparable good to excellent results in both subpopulations (101 (80%) patients from the group of GA and 13 (77%) from the other group). Overall, the results in the function score are better in both groups than in the Knee score. The Knee score showed greater differences between both groups. In the course of radiological follow-up examinations, none of the prostheses showed possible or clear signs of loosening, except for one case of patella failure. The determination of the leg-axis produced the greatest discrepancies between the two scores. Here, a weakness of the HSS score is shown, which does not define the physiological axis of the leg. Nevertheless, the measurement of the axial misalignment is preoperatively one of the most important criteria for the indication of the implantation of a non-constrained knee endoprosthesis. In summary, both groups show significant improvements in both scores in the medium term, combined with a significant increase in the quality of life. The non-constrained knee endoprosthesis Type Foundation has very good functional and stabilizing properties. It thus comes very close to the requirements placed on the physiological biomechanics of a knee joint. Depending on the patient and the position of the implant, the bone-saving implantation technique allows the implantation of a surface glide replacement, possibly also posterior cruciate sparing or posterior sacrificing prosthesis, even after a later replacement of the prosthesis. 2018-02-23 monograph opus:8076