Publikationen

Hier sind einige Veröffentlichungen von Dr. med. Marco Tinius in medizinischen Fachzeitschriften für Sie zusammengestellt.

BMC Musculoskeletal Disorders (2021) 22:326 https://doi.org/10.1186/s12891-021-04185-w
RESEARCH ARTICLE
Better short-term function after unicompartmental compared to total knee arthroplasty
Eric Tille1* , Franziska Beyer1, Kai Auerbach2, Marco Tinius3 3 and Jörg Lützner1
Abstract
Background: Unicompartmental knee arthroplasty (UKA) is an established treatment option for patients with unicompartmental osteoarthritis (OA). However, strict patient selection is crucial for its success. The proposed advantages include nearly natural knee kinematics, faster rehabilitation and better functional outcomes. Despite the aforementioned facts and it’s proven cost-effectiveness, there are still hesitations for the use of UKA as an alternative to total knee arthroplasty (TKA). Key objectives of this study were therefore to assess clinical and patient- reported outcome (PRO) as well as patient’s satisfaction after medial UKA in comparison to TKA.
Methods: To assess the outcome after UKA we conducted a prospective multi-center study. 116 patients with unicompartmental OA and indication for UKA were included. Overall 54 females and 62 males with an average age of 62.7 years (±9.8) and an average body mass index (BMI) of 29.2 (± 3.7) were recruited. Clinical results and PRO were assessed using the Knee Society Score (KSS). Follow-ups took place 3 months, 1 and 2 years after surgery including clinical examination, radiographs, assessment of PRO and adverse events. Pain and satisfaction was evaluated using a visual analog scale (VAS, 0 (worst) to 10 (best)).
For comparison with TKA a propensity score matched-pair analysis was performed to eliminate confounders. Matching criteria were gender, patient’s age, BMI and comorbidities. A total of 116 matched-pairs were analysed.
Results: There was no revision in the UKA group until 2 years after surgery. Revision rates were higher in the TKA group (0.6%).
Preoperative KSS-Scores were higher within the UKA cohort (p < 0.001). After surgical treatment, PROMs displayed a significant improvement (p < 0,001) in both cohorts. Regarding the Knee-Score (Pain, Alignment, ROM) we observed no differences between cohorts after 12 months. The Function-Score demonstrated significantly better results in the UKA cohort (UKA vs. TKA 95 vs 80, p < 0.001). Patient satisfaction was also higher in UKA patients (UKA vs TKA 9.0 vs 8.8, p = 0.019). Conclusion: Patients of both cohorts showed high satisfaction after knee arthroplasty. UKA resulted in higher function scores compared to TKA without increased revision rate during short-term follow-up. Therefore, UKA is a good treatment option for unicompartmental OA. Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
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Better short-term function after unicompartimental compared to total knee arthroplasty/ EFFORT Abstract BalanSys Uni Multicenter Study – preliminary results Tille, Beyer, Auerbach, Tinius, Lützner 2020

Keywords: unicompartimental knee arthroplasty, endoprosthetic, joint replacement, osteoarthritis
Background Unicompartimental knee arthroplasty (UKA) is an established treatment option for patients with unicompartmental osteoarthritis (OA). However, a strict patient selection is crucial for its success. The proposed advantages include nearly natural knee kinematics, a faster rehabilitation and better functional outcomes. Despite the aforementioned facts and the cost-effectiveness, there are still hesitations for the use of UKA as an alternative to total knee arthroplasty (TKA). Objectives Key objectives of this study were to assess clinical outcome, patient-reported outcome (PRO) and patient’s satisfaction after UKA and comparison to TKA. Design and Methods In order to assess the outcome after UKA we conducted a prospective multi-center study. 116 patients with unicompartimental OA and indication for knee arthroplasty were included. Overall 54 females and 62 males with an average age of 62.7 years (±9.8) and an average BMI of 29.2 (± 3.7) were recruited. All patients received UKA (BalanSys UNI, Mathys, Switzerland). Clinical results and PRO was assessed using the Knee Society Score (KSS, Knee Score and Function Score). Follow-up visits took place 3 month, 1 and 2 years after surgery including clinical investigation, radiographs, KSS and assessment of adverse events. Satisfaction was assessed using a visual analog scale (VAS) from 0 (worst) to 10 (best). For comparison with TKA a propensity score matche-pair analysis was to performed to eliminate confounders. Matching criteria were gender, patient´s age, body mass index (BMI) and musculoskeletal morbidity. 116 matched-pairs could be analysed. Results There was no revision in the UKA group until 2 years after surgery, revision rates were higher in the whole TKA group (0.6%). Preoperative KSS-Scores were higher within the UKA cohort (p < 0.001). After surgical treatment, all PROMs showed a significant improvement (p < 0,001) in both cohorts. The Knee-Score (Pain, Alignment, ROM) after 12 months displayed slightly better results for patients receiving TKA (TKA vs. UKA, 94 vs. 90, p<0.05) which might be due to intended varus alignment in UKA. The Function-Score demonstrated significantly better results in the UKA cohort (TKA vs. UKA 80 vs 95, p <0.001). Patient satisfaction was also slightly higher in UKA patients (TKA vs. UKA 8.8 vs 9.0, p<0.05). Conclusion Overall patients of both cohorts showed a high satisfaction after knee arthroplasty. UKA resulted in higher function scores compared to TKA. Therefore, UKA is a good treatment option for unicompartimental OA.

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Dr. Marco Tinius
Painful TKA why is it unstable?

Abtractbook 4th international knee update Davos 2014

Despite more modern TKA Sytems that introduced and respected features like new alignment theories, better surfaces, materials etc., a percentage of patients feel unstable with her new knee.Additional to them a couple of patients have pain behind the patella, which can be the reaction of an unstable knee after TKA.Reasons for instability conjoint to surgery can be found in e.g. incorrect resection high and therefore creation of an incorrect rotational center or using false size of prostheses or liner.As a result of these problems, muscle coordination goes fail and muscles have to cover this coordination deficits by hypertension. The resulting trigger points, tender points and functional malfunction cumulates in pain as well which is often a expression of instability.Cruciate ligaments and the collaterals play the keyrole. They have to be adressed with correct resection parameters (jointline restauration), optimal sizing and a sufficient thickness of liner. Particularly a to thin liner leads to a functional to long appeared PCL, which is responsible for a false movement pattern of the knee joint, different role back, overload of muscles and not at least for back pain.To solve this, surgeons have to plane carefully the restauration of joint line, sizing and fitting of a TKA. There are different alignment philosophies for correct rotational center – the anatomical alignment, the mechanical alignment and the kinematic alignment. Every alignment demands the fitting shape of prostheses (j-curve / single radius / individual design) and the correct resection for joint line. So the instability can be avoided effectively and knees will have a correct tension of ligaments and less pain that are triggered by the overstretched muscles. A magic bullet has not really found until now, but surgeons have to consider all this in their TKA.

Dr. Marco Tinius
Pulstreiber 2013 Gesamtausgabe

Kreuzbandverletzungen Wie kann man sie vermeiden, wann müssen sie operiert werden?

Verletzungen der Kreuzbänder gehören zu den häufigsten Schäden am Kniegelenk. Mit einer Grundkenntnis am Aufbau und der Funktionsweise der Kreuzbänder lassen sich effektiv Verletzungen vermeiden und im Bedarfsfall sicherer rehabilitieren.Die Funktion der KreuzbänderDas Kniegelenk besteht aus den zusammentreffenden Enden des Oberschenkelknochens und des Schienbeines. Da die Knochen anatomisch nicht passend sind (Schienbein gerade, Oberschenkelende rund) erfüllen die Menisken als „Unterlegscheiben“ eine Pufferfunktion. Um diese Strukturen (und damit das Kniegelenk selbst) zu kontrollieren, müssen die beiden Kreuzbänder die gesamte Muskulatur steuern, um ein Wegrutschen zu verhindern. Um alle Richtungen zu erfassen, sind sie „kreuzend“ (daher der Name) und dreidimensional zueinander verlaufen angeordnet. Diese beiden Bänder sind jedoch nicht als „Sicherheitsgurte“ zu verstehen, sondern sind vielmehr Messgeräte mit Rezeptoren, die die Stellung des Kniegelenkes, die Spannung und den Druck im Gelenk permanent ermitteln und an das Rückenmark weitergeben. Nach der Informationsübertragung erfolgt dort eine Impulsgabe an die Nerven, die die Kniegelenksmuskulatur ansteuern. Dieser Kreislauf wird als Propriozeption bezeichnet und kann durch eine Schädigung der Kreuzbänder unterbrochen werden. Nicht der Riss der Kreuzbänder an sich, sondern der Verlust dieses Regelkreislaufes führt zu einer Instabilität und zu Muskelminderungen.(etc.)

Marco Tinius(1), Stefan Klima(2), Timo M. Ecker(3)
ESSKA best practice 2013

Chapter 4: Ligament balancing for unicompartmental knee replac.
Reconstruction of the anterior cruciate ligament and unicompartmental knee arthroplasty: technical notes and preliminary results

(1) Center for Joint Surgery / Knee Group Praxisklinik-Stollberg Hohensteiner Strasse 56 09366 Stollberg Germany – Phone: +49 37296 / 926631(2)Department of Orthopaedic, Trauma and Reconstructive Surgery, University of Leipzig, Germany (3)Department of Orthopaedic Surgery, Inselspital, University of Berne, Switzerland Introduction Unicompartmental knee arthroplasty (UKA) has become a common procedure for treat- ment of monocompartmental osteoarthritis since the design of endoprostheses and recent improvements in operative techniques. The clear advantages of UKA are minimised tissue trauma through mini-arthrotomy, short opera- tive times, low complication rates, faster reco- very and kinematics similar to the normal knee. Furthermore, the possibility to perform the pro- cedure in an out-patient/day-patient setting is increasingly important in these times of strict cost-efficiency requirements [4]. When determi- ning the indications to use a unicompartmental knee system, several important key points have to be considered. It is evident that the progres- sion of osteoarthritis should not exceed stage 2 in the contralateral compartment [7]. Regar- ding the patellofemoral joint, not the level of cartilage damage but rather the subjective pain perception of each patient is important when making decisions regarding UKA [3].In terms of the ligamentous integrity of the joint to treatment, it is clear that due to limited number of balancing and prosthetic-stabilisa- tion options, the joint capsule, as well as the cruciate and collateral ligaments, need to be intact. The consensus is that, in a case of insuf- ficient ACL function, a reconstructive proce- dure is mandatory when planning to perform UKA [10]. This is especially apparent in younger patients who are still working and wish to enjoy a fairly active lifestyle. Apart from patients with insufficient ACL prior to UKA, a similar problem is encountered in patients who present with ACL pathology and have already received UKA.These patients, however, need to be carefully evaluated to determine whether the prosthe- sis itself lead to ACL failure (e.g., too high of a slope, notching, etc.). Once this is excluded, these patients can be treated in a similar man- ner as primary UKA patients.Reconstruction of the anterior cruciate ligament (ACL) can be achieved using the semitendino- sus/gracilis tendon. This operative technique requires a strict workflow, which is also dictated by time restraints due to the use of a tourniquet throughout the procedure. Several pearls and pitfalls exist. Recognition and consideration of these will aid the surgeon during this operation. Both techniques—the combination procedure (simultaneous UKA and ACL-replacement in one session) and ACL replacement with a previously implanted UKA (two-session treatment)—are rarely described in the current literature.This article presents a technical note elabora- ting on the general operative technique, highli- ghting the pears and pitfalls. Moreover, we pre- sent preliminary results from our institution.

Marco Tinius

Knee kinematics in partially and totally deficiant ACL

Abtractbook 3th international knee update Davos 2013

Knee kinematics in partially and totally deficient ACLExact knowledge of normal working knee kinematics and changes occuring due to deficiency of ACL are important as conditions for current high quality management of ACL injuries. In the past, the AM portion of ACL was more respected by knee surgeons because it seemed to be more relevant for the rotational and translational stability of the knee joint and shows the smallest change of length during whole ROM. Current concepts have shown that the kinematics in natural knee joints need more than the AM bundle of ACL for well working knee kinematics.Many well-designed studies show further the importance of additional stabilizers of knee joints, e.g. the posterolateral complex, the collateral ligaments and not least the meniscals. No consenus could be reached so far in terms of the reasons of the OA that follows the ACL damage as well as the ACL replacement.While some investigators blame the not well restored rotational stability after an ACL replacement with a single or a double bundle, other publications assume ignored accompanying injuries of the additional stabilizers of the knee to be the cause for instabilityMostly forgotten, the muscels that work towards the knee joint only start to be interesting after the ACL replacementand. In journals not edited of operative surgeons, some interesting theories can be found. The idea of a complete erasure of the knee’s capsulary pattern by replacing the ACL to give the knee (has) the chance to build a new sensomotorical capsulary pattern seems to be interesting. The new pattern is made by the new anatomic setup the surgeon creates inside the knee. So proprioceptive system can be particularly justified for the own kinetics of the patient’s knee but may be different to the time before the deficiency of ACL. This system has a great forgiveness as we can see from some not ideally replaced ACL in patients who are happy to return to sports without instability. This could explain the number of different methods to replace ACL, the generally good results and the well-working knees with a partially deficient ACL. The “patient ́s own kinetic” theory is proven by studies conducted after UKA and for the kinematic alignment theory as well. Contingently the creating of a new proprioceptive system by a well-developed physiotherapy in addition to a – within particular limits -replaced ACL could be a working title in the future.

Marco Tinius

Failed Uni – causes and treatment options

Abtractbook 3th international knee update Davos 2013

Major advantages of the unicompartmental knee arthroplasty (UKA) is the quick rehabilitation, small traumatization of the tissue and the respect for the patient’s own kinetics. Due to an increased number of active elderly patients and the mistakenly assumed ease of revision of a uni knee, we have to expect an increased count of revisions of UKA. According to literature, the conversion into a TKA is the best solution. This revision showed inferior results in comparison to the primary TKA. Often a number of minor problems can be identified and should probably be treated by means of minor revisions to maintain the advantages of UKA and thereby to avoid an untimely implanted TKA. The aim of the study was to examine whether the conversion to the total endoprosthesis is always necessary or whether a revision can have good chances of success with receipt of the unicondylare system under certain conditions.116 revisions after unicompartmental knee arthroplasty were studied at first appearance of problems and during the follow-up of 45 months (10-86) using the Knee Society Score. The study analyzed the various additional procedures as well as the anterior cruciate ligament substitute, the correction of slope, etc. Furthermore, revisions with and without exchange of components and conversion to a total arthroplasty were included. In 60.3 percent of all cases a revision could be performed within the unicompartmental knee system, at a mean score of 167.4 (144-173). The outcome-score corresponded to the outcome of primary UKA implantations and to conversion operations into TKA at the literature (p < 0,05 Wilcoxon test). Under critical contemplation of the low case number and this short- to medium-term examination, individual revision solutions seem to be justified within the unicondylar system as well as a conversion operation to the TKA. Long term results and larger case numbers are absolutely necessary prior to further judgment.

Marco Tinius, Hepp P, Becker R.

Knee Surg Sports Traumatol Arthrosc. 2012 Jan;20(1):81-7. doi: 10.1007/s00167-011-1528-7. Epub 2011 May 11.

Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction. Center for Joint Surgery, Knee Group, Praxisklinik- Stollberg, Hohensteiner Strasse 56, 09366, Stollberg, Germany, PURPOSE: Patients presenting anterior cruciate ligament (ACL) deficiency and isolated osteoarthritis of the medial compartment are treated either with biplanar osteotomy or with total knee arthroplasty (TKA). However, these patients between the forties and fifties are often very active in daily life and feel limited due to their knee. In order to follow the idea of preserving as much as possible from the joint, the concept of unicondylar joint replacement in conjunction with ACL reconstruction has been followed. There seems to be a limited experience with this concept. The purpose of the follow-up study was to evaluate the midterm clinical and functional outcome.Methods: Twenty-seven patients were followed up for 53 months. The mean age of the 11 men and 16 women was 44 years. All patients were treated by combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction.Results: The Knee Society Score improved significantly from 77.1 ± 11.6 points to 166.0 ± 12.1 points (P ≤ 0.01). No revision surgery was required and no radiolucent lines were observed on the radiographs at the time of follow-up. The anterior translation showed less than 5 mm in 24 patients and 5 mm in the remaining 3 patients. Conclusions: The midterm clinical data have shown that combined surgery of UKA and anterior cruciate ligament reconstruction has revealed promising results. The restored knee stability seems to prevent the failure of UKA. However, long-term follow-up studies are required in these patients who received partial joint replacement fairly early in their life. LEVEL OF EVIDENCE: IV.

Marco Tinius, T.M. Ecker, W. Tinius

OP 2008 ,44, 2, Seite 230-236

Implant Preserving Treatment Options after Complications with Unicondylar Knee Artrhoplasty – an Analysis of 64 cases Introduction: The rationale behind unicondylar knee arthroplasty is to successfully provide prosthetic treatment for mono-compartmental arthritis and at the same time decrease tissue trauma, accelerate rehabilitation and provide good range of motion and mobility. Further advantages are low morbidity, good revision characteristics, preservation of bone stock for future arthroplasty and economic efficiency. In case of complications, the most frequent treatment option is conversion to total knee arthroplasty. However, after careful evaluation, in some cases it may be possible to address the complication without sacrificing the implant. Our goal was to investigate these possibilities and show the short term results of implant-preserving revision for complications after unicondylar knee arthroplasty. Material and methods:Following a distinct and standardized diagnostic workup we excluded any revision that was converted to TKA or where a prosthetic component was exchanged. This left 64 cases with occurrence of complications 43 months (range 3 – 77) postoperatively, that were treated without prosthetic exchange. Patients were evaluated clinically with the KSS score pre and post revision surgery. The treatment algorithm was adjusted according to the type of complication that had occurred. Recurrent or persistent complications after the index revision were recorded. Results:The initial KSS score at the time of occurrence of complications was 94.9 (range, 81 – 104) and it significantly (p=0.05, Wilcoxon test) improved to 160 (134 – 169) at 41 months (range 10 – 94) after revision. Three patients ultimately had to be converted to TKA and two patients passed away for reasons notrelative to surgery. The followup for those 5 patients was 31 (range 26 – 40) months. Three other patients complained of persisting symptoms without correlating pathology. Discussion and conclusion: Our short term results with implant- preserving revision surgery are encouraging. While preserving the prosthesis and procrastinating the need for a conversion to TKA, the significant improvement in scores is concurrent with the results achieved with conversion tototal knee arthroplasty or procedures with component exchange, as reported in the literature. Despite these results, this approach is not applicable to every patient and the indication is dependent on a careful workup. Long-term results are needed to confirm these promising early results.Implantaterhaltende Massnahmen bei Problemen mit unicondylären Endoprothesen am Kniegelenk – Eine Analyse von 64 Komplikationen Die Philosophie der Monoschlitten beruht unter anderem auf einer adäquten Versorgung der unicompartmentellen Arthrosen bei geringerer Traumatisierung des Gewebes mit sehr guten Bewegungsausmassen für genügend Mobilität sowie einer schnellen Rehabilitation. Weitere Vorteile liegen in günstigen Revisionseigenschaften, geringer Morbidität und effizienten Kosten. Treten Probleme mit diesem Prothesentyp auf, erfolgt als häufigste Lösung die Konversionen zur Totalendoprothese. Bei bestimmten Revisionsindikationen ist es jedoch möglich, implantaterhaltend vorzugehen. Ziel der vorliegenden Studie war es die Möglichkeiten und die Frühergebnisse dieser implantaterhaltenden Revisionsprozeduren bei Komplikationen nach unicondylären Endoprothesesen(UKA) zu untersuchen. Ausgeschlossen wurden alle Revisionen, bei denen eine Prothesenkomponente getauscht oder in eine Totalendoprothese (TKA) umgewandelt wurde. Wir analysierten 64 problematische Schlittenendoprothesen zum Zeitpunkt der Komplikation und in einem Follow-up von 41 Monaten (10 – 94 mit dem KSS-Score. Die Behandlungsschemata wurden den Indikationen zugeordnet.Bei einem Endscore von 160134 – 169) wurde eine signifikante Verbesserung (p<0,05, Wilcoxon-Test) zum präoperativen Wert erreicht. Diese Ergebnisse entsprechen denen nach Konversionsoperationen zur TKA und nach UKA-Komponententausch. Auch wenn Langzeituntersuchungen noch ausstehen, so zeigten die implantaterhaltenden Reeingriffe durch ihre Minimalinvasivität und signifikante Scoreverbesserungen bei entsprechenden Indikationen ihren Wert.

Marco Tinius, T.M. Ecker, S. Klima, W. Tinius , C. Josten

Unfallchirurg 2007 110:1030-1038

Minimally invasive unicondylar knee arthroplasty with simultaneous ACL reconstruction. Treatment of medial compartment osteoarthritis and cruciate ligament defect

Abstract,Background. Low postoperative pain level, decreased length of hospital stay and accelerated rehabilitation are the major benefits of unicondylar knee arthroplasty. Especially in comparably young, not yet retired and still active patients with an isolated medial gonarthrosis, these prostheses offer many advantages. However, one important requirement to be treated with such implants is a well functioning stability system of the muscles and ligaments. Thus in patients with degenerated or destroyed anterior cruciate ligaments it is contraindicated to use this method. In order to still take advantage of this therapy for treatment of isolated arthrosis, reestablishment of the proprioceptive structures through simultaneous or staged ACL reconstruction is mandatory.Patients and methods. Pursuing this goal we performed unicondylar knee arthroplasty with simultaneous ACL reconstruction on eligible patients. Between 2003 and 2006 we treated 32 knees with this combined surgery and followed them for a mean of 31 months (range: 10–38).Results. The mean Knee Society Score significantly improved from 83.2 (44–103) to 167.6 (145–177) at a mean follow-up of 31 months (10–38).Conclusions. Preliminary results of this short-term follow-up are promising. Especially the predominant number of patients who were able to return to work soon after rehabilitation and the significantly improved score postoperatively reflect the benefits of this prosthesis system in select patients. However, long-term follow-up and larger case numbers are necessary to confirm these encouraging results in the future.Keywords Unicondylar knee arthroplasty · Anterior cruciate ligament · Osteoarthritis/

Zusammenfassung,Hintergrund. Geringe postoperative Schmerzen, eine rasche Rehabilitation, kurze stationäre Liegezeiten sowie eine kaum gestörte Achsenkinetik bilden die Vorteile der unikondylären Versorgung von medialen Arthrosen. Notwendige Voraussetzung hierfür sind eine muskuläre und ligamentäre Stabilität. Bei biologisch jungen, aktiven Patienten (<60 Jahre) mit einer isolierten medialen Gonarthrose und zusätzlicher vorderer Kreuzbandinsuffizienz ist der unikondyläre Gelenkersatz kontraindiziert. Um in diesen Fällen die Vorzüge der unikondylären Endoprothese bei lokalisierter Arthrose nutzen zu können, ist die Wiederherstellung der Bandstabilität notwendig.Material und Methoden. Mit diesem Ziel implantierten wir an ausgewählten Patienten eine unikondyläre Endoprothese und führten zusätzlich eine vordere Kreuzbandplastik durch. Von 2003–2006 operierten wir 32 Fälle mit dieser Kombinationsoperation und untersuchten sie in einem Follow-up von 31 (10–38) Monaten nach.Ergebnisse. Der Knee-Society-Score (KSS) erhöhte sich signifikant von präoperativ durchschnittlich 83,2 (44–103) auf 167,6 (145–177) nach 31 (10–38) Monaten (Wilcoxon-Test, p<0,05). Schlussfolgerung. Wenngleich Langzeit-ergebnisse fehlen und größere Patienten-kollektive für fundierte Aussagen unabdingbar sind, ermutigen die erfolgreiche Rehabilitation und die Steigerung im KSS und könnten somit Anlass zur Erweiterung des Indikationsspektrums für den unikondylären Oberflächenersatz geben.SchlüsselwörterUnikondyläre Endoprothese · Kreuzbandplastik

Marco Tinius, S. Klima, W. Tinius, Josten, C.

Unfallchirurg 2006; 109: 1104-1108

Reconstruction of the ligamentum cruciatum anterius during the performance of unicondylar knee arthroplasty by minimally invasiv surgery : A salvage procedure for monocondylar arthrosis and downfall of the anterior cruciate ligament. Die additive Kreuzbandplastik bei der Implantation von unicondylären Endoprothesen mittels Miniarthrotomie am Kniegelenk – Eine Lösungsmöglichkeit bei unilateralen Arthrosen mit Kreuzbandverlust.

Zusammenfassung:Die Behandlung von monolateralen Arthrosen des Kniegelenkes durch unicondyläre Endoprothesen mittels Miniarthrotomie (UEP) befindet sich nach wie vor in Diskussion. Einigkeit besteht für diese Prothese in der Notwendigkeit suffizienter Kreuzbänder. Vor allem für biologisch jüngere Patienten im Arbeitsprozess mit hochgradiger medialer Arthrose und fehlendem oder insuffizienten vorderen Kreuzband sind dieser Versorgung Grenzen gesetzt. Um hier die Vorteile der unicondylären Endoprothese nutzen zu können, haben wir bei 7 Patienten diesem Gelenkersatz mit einer gleichzeitigen vorderen Kreuzbandplastik mittels Semitendinosus-/ Grazillessehne in Transfixtechnik kombiniert. Präoperativ und im Follow up von 12- und 28 Monaten wurden Einstufungen in den Knee Society Score vorgenommen. Auch wenn Langzeitergebnisse noch ausstehen, zeigte diese Operationsmethode mit einem Outcome von durchschnittlich 164,1 Scorepunkten nach über 2 Jahren bei einer Berufsrückkehr aller Patienten ihre Effektivität und ein Patientenbenefit.Summary:There are different opinions about the treatment of the unicompartmental osteorthritis of the knee with a unicompartmental knee replacement. It is nessesary to have a well functioning anteror cruciate ligament to use this prostheses. This is mainly important for older people who are still employed. To keep the advantages of this unicondylar replacement for these group of patients during the performance of unicondylar knee arthroplasty by minimally invasiv surgery we reconstruct in 7 cases the anterior cruciate ligament. The mean knee society score improved to 164,1 points postoperatively (follow up 28 months). All patients could return to work after the rehabilitation. So this method shows at the short term follow up the posibility of treatment and a benefit for the patients.

Marco Tinius, S. Klima, B. Marquass, W. Tinius, C. Josten

Z Orthop Ihre Grenzgeb 144/4 367-372, 2006

Salvage procedures after failed unicompartmental knee arthroplasty–an analysis of 116 revisions

Revisionsmöglichkeiten nach Problemen mit unikondylären Endoprothesen – Eine Analyse von 116 Operationen

Zusammenfassung Studienziel:Ein Vorteil der Unischlitten ist neben geringerer Traumatisierung des Gewebes unter anderem eine schnelle Rehabilitation und die zumeist unkomplizierte Revision auf einen bicondylären Oberflächenersatz. Untersucht werden sollte, ob die Konversion zur Totalendoprothese, wie sie derzeit bei Versagen des Schlitten-Systemes häufig empfohlen wird, immer notwendig ist oder ob eine Revision mit Erhalt des unicondylären Systemes unter bestimmten Bedingungen gute Erfolgsaussichten haben kann.Methode:Es wurden 116 Revisionen nach unikompartimentären Ersatz am Kniegelenk zum Zeitpunkt des Auftretens des Problems und im follow-up von 45 Monaten (10-86) mit dem Knee Society Score untersucht und das differenzierte Vorgehen sowie die Zusatzproceduren (Kreuzbandersatz, Slopekorrektur usw.) analysiert. Einbezogen wurden Revisionsoperationen, bei denen ein Austausch von Komponenten oder eine Konversion zur Totalendoprothese notwendig war.Ergebnisse:Bei einem durchschnittlichen Endscore von 167,4 (144-173) konnte bei 60,3 % aller hier betrachteten Operationen innerhalb des Schlittensystemes revidiert werden. Die ermittelten Scorewerte entsprachen dem Outcome nach primären UEP Implantationen und den Ergebnissen von Konversionsoperationen zur Totalendoprothese im Literaturvergleich (p<0,05, Wilcoxon Test).Schlussfolgerung:Unter kritischer Betrachtung der geringen Fallzahl und der kurz- bis mittelfristigen Untersuchung, scheinen individuelle Revisionlösungen innerhalb des unicondylären Systemes ebenso ihre Berechtigung zu haben wie Konversionsoperationen zur TEP. Langzeitergebnisse und größere Fallzahlen sind für weitere Beurteilungen unbedingt notwendig.Summary: Aim:A major advantage of the unicompartmental knee arthroplasty (UKA) is the quick rehabilitation, small traumatization of the tissue and the mostly uncomplicated revision to a total knee arthroplasty. The aim of the study is, to examine whether the conversion to the total endoprosthesis, as it is frequently is recommended at present in case of defection of the sleigh system, is always necessary or whether a revision can have good chances of success with receipt of the unicondylare system under certain conditions.Method:116 revisions were studied after unicompartmental knee arthroplasty at first appearance of problems and during the follow-up of 45 months (10-86) using the Knee Society Score and analyzes the various additional procedure as well as the anterior cruciate ligament substitute, the correction of slope etc.. Revision, with exchange of components or a conversion to a total arthroplasty were included. Results:In 60,3 percent of all cases a revision could be performed within the unicompartmental knee system, by a mean score of 167,4 (144-173). The Outcome-Score corresponded to the outcome of primary UKA implantations and to conversion operations to total endoprosthesis in the literature (p < 0,05 Wilcoxon test).Conclusion:Under critical contemplation of the low case number and this short- to medium-term examination, individual revision solutions seem to have their entitlement within the unicondylar system as well as a conversion operations to the TKA. Long term results and larger case numbers are absolutely necessary prior to further judgment.

Marco Tinius, S. Klima, B. Marquass, W. Tinius, C. Josten

Aktuelle Traumatologie 36 Jahrgang, Oktober 2006, Seite 223ff

Salvage procedures after failed unicompartmental knee arthroplasty–an analysis of 116 revisions

Summary

Aim: A major advantage of the unicompartmental knee arthroplasty (UKA) is the quick rehabilitation, small traumatization of the tissue and the mostly uncomplicated revision to a total knee arthroplasty. The aim of the study is, to examine whether the conversion to the total endoprosthesis, as it is frequently is recommended at present in case of defection of the sleigh system, is always necessary or whether a revision can have good chances of success with receipt of the unicondylare system under certain conditions.Method:116 revisions were studied after unicompartmental knee arthroplasty at first appearance of problems and during the follow-up of 45 months (10-86) using the Knee Society Score and analyzes the various additional procedure as well as the anterior cruciate ligament substitute, the correction of slope etc.. Revision, with exchange of components or a conversion to a total arthroplasty were included.Results:In 60,3 percent of all cases a revision could be performed within the unicompartmental knee system, by a mean score of 167,4 (144-173). The Outcome-Score corresponded to the outcome of primary UKA implantations and to conversion operations to total endoprosthesis in the literature (p < 0,05 Wilcoxon test).Conclusion:Under critical contemplation of the low case number and this short- to medium-term examination, individual revision solutions seem to have their entitlement within the unicondylar system as well as a conversion operations to the TKA. Long term results and larger case numbers are absolutely necessary prior to further judgment.

Marco Tinius, S. Klima, C. Josten

OP Journal 2006: 22 176-181

Posttraumatische unikondyläre Endoprothetik

Zusammenfassung: Die Implantation einer Schlittenprothese nach Verletzung der gelenknahen knöchernen und Weichteilstrukturen unterliegt generell den Prinzipien der unikondylären Knieendoprothetik. Voraussetzung für den Erfolg ist eine fundierte Indikationsstellung. Achskorrekturen sind kaum möglich, bei Fehlstellungen sind Kompromisse in Grenzen möglich. Bei fehlendem VKB ist die klinische und subjektiv empfundene Instabilität wegweisend. Der Einsatz der Navigation kann das Risiko einer Fehlimplantation verringern.

Dr. Marco Tinius, Dr. Werner Tinius , Prof. Dr. Christoph Josten

Orthopädische Praxis 7/2006, 42 Jahrgang,Seite 411ff

Prädiktive Werte von Radiolucent lines, Szintigraphie und Arthroskopie bei der aseptischen Lockerung von unicondylären Endoprothesen mittels Miniarthrotomie

Eine prospektive Studie von 503 Fällen.

Zusammenfassung Effektive und sichere Kontrollmechanismen zum Ausschlussaseptischer Lockerungen sind im Bereich der Kniegelenksendoprothetik wichtig. Die Untersuchung umfasst 503 minimal-invasiv implantierte unicondyläre Knieendoprothesen aus den Jahren 2000 bis 2002. 24 h postoperativ, nach 6 Monaten sowie nach 1, 2 bzw. 3 Jahren wurden klinische und radiologische Kontrollen durchgeführt, wobei subjektive Angaben wie Schmerz, Instabilität sowie objektive Parameter wie Inzidenz und Variationen von Radiolucent Lines, Szintigraphie, Arthroskopie und Miniarthrotomie verwendet und ihre Vorhersagewerte für eine aseptische Lockerung bestimmt wurden. Lediglich die Arthroskopie in Verbindung mit einer im Bedarfsfalle nachfolgenden Miniarthrotomie zeigte diagnostisch verwertbare Ergebnisse bzgl. einer aseptischen Lockerung. (Sensitivität 93,33 %, Spezifität 100 %, positive Prädiktion 100 %, negative Prädiktion 91,66 %). Die Arthroskopie (Minarthrotomie) erlaubt eine reliable, genaue, zeitnahe Diagnostik. So konnte bei Ausschluß einer aseptischen Lockerung sofort eine Kausaltherapie durchgeführt werden und im Falle von gelockerten Komponenten in der gleichen Sitzung eine Revision oder Konversion zur TEP angeschlossen werden. Arthroskopie bzw. Miniarthrotomie können im Rahmen der Diagnostik von aseptischen Lockerungen bei unicondylären Knieendoprothesen als effektive Strategien empfohlen werden.

Summary:The study includes 503 unicondylar knee endoprostheses implanted by minimal invasive surgery (UKA) between 2000 and 2002. In order to exclude their aseptic loosening, we carried out clinical and radiological controls after 24 hours, six months and after one, two and three years. Pain, instability, incidence and variation of radiolucent lines, scintigraphy, arthroscopy and miniarthrotomy were used for diagnostic purposes, and the predictive values of these parameters determined. Only arthroscopy, which together with miniarthrotomy was, subsequently carried out where necessary, showed diagnostically useable results with regard to aseptic loosening. In addition, different postoperative problems such as pseudomeniscus and cord formation could be causally treated by arthroscopy thereby ensuring rapid diagnosis and therapy. In case of aseptic loosening it was possible to include the causually treatment, such as revision inside the unicompartmental knee system or upgrade to a total knee arthroplasty, in the same session. Owing to the above advantages, we can recommend arthroscopy as an efficient strategy for safe and efficient patient care in the diagnosis of persistent pain after UKA implantation despite its invasivity.

Dr. Marco Tinius, Dr. Werner Tinius , Prof. Dr. Christoph Josten

Kongressausgabe der Orthopädischen Nachrichten zum Deutschen Orthopäden Kongress Baden Baden 2006

Predictive values of RLL at the unicondylar knee endoprostheses

A prospective controlled study

he study includes 503 unicondylar knee endoprostheses implanted by minimal invasive surgery (UKA) between 2000 and 2002. In order to exclude their aseptic loosening, we carried out clinical and radiological controls after 24 hours, six months and after one, two and three years. Pain, instability, incidence and variation of radiolucent lines, scintigraphy, arthroscopy and miniarthrotomy were used for diagnostic purposes, and the predictive values of these parameters determined. Only arthroscopy, which together with miniarthrotomy was, subsequently carried out where necessary, showed diagnostically useable results with regard to aseptic loosening. In addition, different postoperative problems such as pseudomeniscus and cord formation could be causally treated by arthroscopy thereby ensuring rapid diagnosis and therapy. In case of aseptic loosening it was possible to include the causually treatment, such as revision inside the unicompartmental knee system or upgrade to a total knee arthroplasty, in the same session. Owing to the above advantages, we can recommend arthroscopy as an efficient strategy for safe and efficient patient care in the diagnosis of persistent pain after UKA implantation despite its invasivity.

Dr. Marco Tinius, Dr. Werner Tinius

Orthopädische Praxis 2/2005 41.Jahrgang Seite 58ff

Ist die Navigation bei der Implantation von unicondylären Endoprothesen mittels Miniarthrotomie unter ambulanten Bedingungen sinnvoll

Is it necessary to use a navigation system during the unicompartmental knee arthroplasty by minimally invasive surgery in outpatients ?

Abstract: The Unicompartmental knee arthroplasty (UKA) by minimally invasiv surgery should be performed with a correct alignement of the knee joint. So we can increase the stability and decrease the pain level in the follow up. This may be reached only by restoring the balances of forces going trough the joint line after treatment. So we need a balanced level of undercorrection and a anatomical pattern of postoperative knee movement. The Navigation-system of UKA can be used as a efficient teaching systems for beginners in this field. In addition to that after having more than 1500 UKAs in the outpatient clinic it proves our own quality. This technique is particularly suitable under outpatient conditions

Dr. Marco Tinius, Dr. Werner Tinius

Orthopädische Praxis 2/99 35.Jahrgang Seite 97

Unicondyläre Endoprothetik mittels Miniarthrotomie bei arthrotischen Veränderungen des Kniegelenkes Unicompartmental endosprosthesis by minimal incision technique in ostheoarthritis of the knee

Abstract:The appropriate treatment of osteoarthritis of the knee gains more and more importance caused by the increasing age of the people. All traditional methods, such as arthroscopy, transfer-operation, unicompartmental knee arthroplasty according to conventional methods and the total knee replacement show different disadvantages. Since 1997 we have implanted unicompartmental repicci II endosprosthesis by minimal incision technique in 73 cases.Indication must include anamnesis, clinical inspection, x-ray examination and arthroscopy as the most important assumption. In our opinion, the method presented seems to eliminate the generally-known disadvantages of the traditonal treatment in arthrosis. The repicci II system takes care of the healthy structures of the knee joint and replaces only the destroyed cartilage. The 3 inch incision is less tramatic than the traditional technique so that the post-op. process is accelerated. As a result of these findings we prefer this method for the treatment of outpatients at present. Windsheimer,J et.all, Praxisklinik-Stollberg, Die Hochfrequenzversiegelung von hyalinen Knorpelschäden, Chirurgie vol 2 Seite 14ff, Sympomed München 1997 (Hrsg: Keller, Wuschech) Zusammenfassung: Wir berichten über eine Versuchserie, die wir dem Gesamtkonzept der arthroskopischen Arthrosetherapie zuordnen möchten. Die Untersuchungen zeigten, dass die Hochfrequenzversiegelung am Knorpel des Kniegelenkes bei Knorpelschädigungen II-III nach Outerbridge wesentlich schonender als die Laseranwendung in diesem Bereich ist. Die Laser entwickelten noch in tieferen Bereichen Temperaturen über 82° C, weshalb sie nicht ohne Bedenken zum Einsatz kommen sollten. Die Anwendung einer speziellen HF Eingangssonde, welche die Stromdichte im Gewebe niedrig hält, zeigte die besten Ergebnisse und ist für den Einsatz in der Praxis zu empfehlen

Dr. Marco Tinius, Dr. Werner Tinius

Buchbeitrag in: Arthroskopische Gelenkchirurgie congress compact-Verlag 2002 (Hrsg:Frenzel,Wuschech) Seite247 ff.:

Hemigonarthrose-Behandlungsmöglichkeiten mit unicondylärer Endoprothese

Zusammenfassung: In unserer Praxisklinik wurden seit 1997 705 Patienten mit einer unicondylären Schlittenprothese mittels Miniarthrotomie versorgt.Diese Methode kommt unserer Meinung nach ohne die den anderen Verfahren anhaftenden Nachteile aus. Sie schont in optimaler Weise die noch witgehend erhaltenen Strukturen des erkrankten Gelenkes und ersetzt trotzdem ausreichend das zugrunde gegangene Areal. Untersuchungen konnten zeigen, dass die unicondyläre Endoprothese mit Miniarthrotomie hinsichtlich der kurz- und mittelfristigen Ergebnisse ein geeignetes Instrument darstellt, eine fortgeschrittene monokompartementelle Arthrose zu behandeln. Sie wird von uns gegenwärtig bei der ambulanten endoprothetischen Versorgung unicompartementeller Arthrosen im entsprechenden Stadium favorisiert

Publikationen

Chapter 4: Ligament balancing for unicompartmental knee replac. Reconstruction of the anterior cruciate ligament and unicompartmental knee arthroplasty: technical notes and preliminary results

Chapter 4: Ligament balancing for unicompartmental knee replac.
Reconstruction of the anterior cruciate ligament and unicompartmental knee arthroplasty: technical notes and preliminary results