[Total knee arthroplasty in the young patient-an update].
Bikondylärer Oberflächenersatz des Kniegelenkes beim jungen Patienten – ein Update.
Lower extremity
Middle age
Osteoarthritis
Patient satisfaction
Total knee replacement
Journal
Der Orthopade
ISSN: 1433-0431
Titre abrégé: Orthopade
Pays: Germany
ID NLM: 0331266
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
accepted:
12
03
2021
pubmed:
10
4
2021
medline:
1
5
2021
entrez:
9
4
2021
Statut:
ppublish
Résumé
The absolute number of total knee arthroplasties (TKA) continues to rise every year. About 10% of the patients are less than 55 years of age, although it is known that functional results and patient satisfaction are lower combined with an increased likelihood of revision compared to older patients. Higher physical activity and patient expectations are a major challenge in this age group. At the same time, the incidence of posttraumatic/postoperative alterations is high, including ligamentous or bony deficiencies, which can make the surgical procedure challenging. In view of these facts conservative treatments and joint sparing procedures should always be considered first. The potential correction of lower-limb deformities and unicompartmental knee arthroplasties need to be carefully evaluated before considering total knee arthroplasty. Only in advanced cases of osteoarthritis in more than one compartment of the knee of with combined ligamentous instability, can a TKA provide satisfactory results in the young patient. However, the strongest predictor of satisfaction is a realistic expectation. Die Zahl der durchgeführten Knietotalendoprothesen (KTEP) nimmt jedes Jahr kontinuierlich zu. Ungefähr 10 % davon betreffen Patienten unter 55 Jahren, obwohl bekannt ist, dass in dieser Altersgruppe die Zufriedenheit und die funktionellen Ergebnisse geringer und die Revisionsrate höher ausfällt. Vermehrte Aktivität und erhöhtes Anspruchsdenken machen die Endoprothetik in dieser Altersgruppe zu einer besonderen Herausforderung. Gleichzeitig ist der Anteil posttraumatischer Gonarthrosen deutlich erhöht, was in Anbetracht ligamentärer und knöcherner Vorschäden eine schwierigere operative Versorgung bedeutet. Bei fortgeschrittenen Arthrosen in mehreren Kompartimenten mit/ohne begleitender ligamentärer Instabilität muss jedoch ein totalendoprothetischer Ersatz auch bei jüngeren Patienten erwogen werden. Die sorgfältige Indikationsstellung für die KTEP und die eingehende Patientenaufklärung (Chancen, Risiken, erreichbare Leistungsfähigkeit in Beruf und Alltag) sind gerade bei jüngeren Patienten starke Prädiktoren für ein gutes Resultat.
Autres résumés
Type: Publisher
(ger)
Die Zahl der durchgeführten Knietotalendoprothesen (KTEP) nimmt jedes Jahr kontinuierlich zu. Ungefähr 10 % davon betreffen Patienten unter 55 Jahren, obwohl bekannt ist, dass in dieser Altersgruppe die Zufriedenheit und die funktionellen Ergebnisse geringer und die Revisionsrate höher ausfällt. Vermehrte Aktivität und erhöhtes Anspruchsdenken machen die Endoprothetik in dieser Altersgruppe zu einer besonderen Herausforderung. Gleichzeitig ist der Anteil posttraumatischer Gonarthrosen deutlich erhöht, was in Anbetracht ligamentärer und knöcherner Vorschäden eine schwierigere operative Versorgung bedeutet. Bei fortgeschrittenen Arthrosen in mehreren Kompartimenten mit/ohne begleitender ligamentärer Instabilität muss jedoch ein totalendoprothetischer Ersatz auch bei jüngeren Patienten erwogen werden. Die sorgfältige Indikationsstellung für die KTEP und die eingehende Patientenaufklärung (Chancen, Risiken, erreichbare Leistungsfähigkeit in Beruf und Alltag) sind gerade bei jüngeren Patienten starke Prädiktoren für ein gutes Resultat.
Identifiants
pubmed: 33834286
doi: 10.1007/s00132-021-04104-w
pii: 10.1007/s00132-021-04104-w
pmc: PMC8081686
doi:
Types de publication
Journal Article
Review
Langues
ger
Sous-ensembles de citation
IM
Pagination
395-401Références
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