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Endoprothetik des oberen Sprunggelenks beim Rheumatiker

Total ankle arthroplasty for rheumatoid arthritis

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Zusammenfassung

Moderne Sprunggelenkimplantate der 2. Generation sind heute bei sorgfältiger Indikationsstellung eine ernstzunehmende Alternative zu gelenkversteifenden Verfahrensstrategien. Die vorliegenden mittelfristigen Ergebnisse mit Überlebensraten zwischen 70 und 90% sowie die spätere Rückzugsmöglichkeit zum Prothesenwechsel oder zur Arthrodese lassen heute die Endoprothese des oberen Sprunggelenks zunehmend in den Versorgungsschwerpunkt treten. Gerade der Rheumapatient mit seinem allgemein geringeren physischen Anforderungsprofil kann nach einer gut implantierten Prothese mit einer schmerzfreien Funktion des operierten Sprunggelenks über 8 bis 10 Jahre rechnen. Die rekonstruktive Versorgung mit einer Sprunggelenkendoprothese ermöglicht dem Rheumapatienten im Vergleich zur Fusion eine wesentlich schnellere Remobilisierung mit Erhalt der Abrollvorgänge und Korrekturmöglichkeiten im Sprunggelenk. Die Arthrodese verbleibt als wertvolle therapeutische Alternative bei schweren Destruktionen mit knöchernen Substanzverlusten und Instabilitäten sowie als Rückzugsmöglichkeit nach Fehlschlägen der Endoprothetik.

Abstract

Modern second generation total ankle arthroplasty is now a serious alternative to ankle fusion in patients with rheumatoid arthritis after careful assessment of the indications. The midterm results with 10-year survival rates between 70% and 90% and the possible revision for implant exchange or arthrodesis are the reasons for the increasing importance of ankle arthroplasty. Patients with rheumatoid arthritis in particular with generally lower physical requirements can expect a pain-free function of the operated ankle for 8-10 years. In comparison to fusion ankle arthroplasty allows a significantly faster remobilization and reserves the correction capabilities of the ankle. Arthrodesis remains a valuable therapeutic alternative for severe bony destruction and instability as well as a possible fallback for failure of arthroplasty.

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  1. MVZ-Gelenkzentrum Rosenheim, Schön Klinik Harthausen, Dr.-Wilhelm-Knarr-Weg 1–3, 83043, Bad Aibling, Deutschland

    S. Schill & R. Wetzel

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Correspondence to S. Schill.

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Schill, S., Wetzel, R. Endoprothetik des oberen Sprunggelenks beim Rheumatiker. Z. Rheumatol. 70, 417–422 (2011). https://doi.org/10.1007/s00393-011-0777-7

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