Die Rotationsendoprothese Des Kniegelenks
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Der endoprothetische Ersatz der bei den grossen und dieser Behandlungs methode gut zuganglichen Gelenke des Korpers, des Huft-und des Knie gelenkes, unterscheiden sich in ihrer geschichtlichen Entwicklung und in ihrer aktuellen Problematik. Die Huftgelenksendoprothetik wurde vor mehr als 20 Jahren massgeb lich von Charnley durch die Verwendung des "low-friction" Prinzips und die Fixierung mit Knochenzement beeinflusst. Danach wurden von zu nachst wenigen Arbeitsgruppen modifizierte Konzepte verfolgt. Klinische Erfahrung und die heutigen biomechanischen Kenntnisse sowie die not wendige interdisziplinare Kooperation mit angrenzenden Wissenschaften waren nur angedeutet vorhanden. Die jeweiligen Vorstellungen wurden von mehr oder minder ausgepragtem "engineering feeling" bestimmt. Wahrend manche in der Anfangszeit vermutete Grunde fur Fehlschlage sich als weniger bedeutsam erwiesen, wurden gewichtigere Ursachen fur Langzeitkomplikationen erst spater erkannt. Abriebfragen schienen da mals ein zentrales Problem zu sein. Die Auswirkung der tiefen Spatinfek tion mit ihren Folgeerscheinungen wurde nur nach und nach in ihrer Be deutung erfasst. Den Begriff Biomechanik verwechselte man uber lange Zeit mit Mechanik, und nur zogernd begann sich diese Wissenschaft zu formieren. Heute mussen wir zugeben, dass Biomechanik die Beschrei bung des Langzeitverhaltens des Implantates im menschlichen Korper un ter Belastungsbedingungen ist. Es war zwar einfach, ein Kugelgelenk nachzuahmen - wobei bezeichnenderweise zur Beurteilung im wesentli chen Funktionsparameter herangezogen wurden - heute wissen wir je doch, dass aus biomechanischer Sicht die ausgepragte Storung des Kraft flusses im Knochen nach Implantation einer Huftgelenksendoprothese eine der wesentlichen Ursachen fur die mechanische Lockerung darstellt."
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