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Wechsel von Tumorendoprothesen des Kniegelenks

Review und eigene Ergebnisse

Revision of tumour endoprostheses around the knee joint

Review and own results

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Zusammenfassung

Ursachen für den Wechsel von Tumorendoprothesen des Kniegelenks sind in erster Linie die aseptische Lockerung und der tiefe Protheseninfekt. Mechanische Komplikationen sind durch Verbesserung des Prothesendesigns deutlich in den Hintergrund getreten. Die Rate an aseptischen Lockerungen bei Ersatz des distalen Femurs oder der proximalen Tibia schwankt je nach Beobachtungsdauer und Prothesendesign zwischen 10% und 45%, die Erfolgsrate nach Wechseloperation wird mittelfristig mit 75% angegeben.

Infektionsraten schwanken in der Literatur zwischen 2,9% und 12%. Einzeitige Revisionen kommen beim akuten Infekt ohne Lockerungszeichen in Betracht und lassen in dieser Situation eine Erfolgsrate von 77,8% erwarten. Zweizeitige Prothesenwechsel werden bei multiresistenten Keimen bzw. septischen Lockerungen bevorzugt, mit Erfolgsraten von 74% nach 5 Jahren. Der tiefe Protheseninfekt stellt die folgenschwerste Komplikation im Langzeitverlauf dar, die aufgrund der speziellen Weichteilproblematik nach Tumorresektion nicht selten in einer Amputation endet.

Von Seiten der Autoren konnte die in der Literatur beschriebene nur minimale Verschlechterung des MSTS-Scores trotz der häufigen Operationen bei der Analyse der eigenen Revisionsfälle (9 Frauen, 6 Männer) bestätigt werden (Median 84%).

Abstract

Revision of tumour endoprostheses around the knee joint is mainly caused by aseptic loosening and deep infection. Mechanical complications have been significantly reduced by improvements in prosthetic design. The rate of aseptic loosening after distal femur or proximal tibia replacement ranges from 10% to 45% depending on the time of follow-up and prosthetic design; the success rate after revision averages 75% at midterm follow-up.

The rate of infection reported in the literature varies between 2.9% and 12%. One stage revision may be considered after acute infection without signs of loosening, after which a success rate of 77.8% can be expected. Two stage revision is mainly indicated in multi-resistant microorganisms as well as septic loosening, with a success rate of 75% after 5 years. Deep infection represents the most serious complication in long-term follow-up, often leading to amputation due to soft tissue problems after tumour resection.

The authors were able to confirm the minimal decrease in MSTS score despite the large number of operations (15 patients: nine females, six males; median MSTS score 84%; mean 81%).

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Authors and Affiliations

  1. Klinik für Orthopädie, Medizinische Universität, Graz, Österreich

    R. Windhager, A. Leithner & M. Hochegger

  2. Klinik für Orthopädie, Medizinische Universität, Auenbruggerplatz 7, 8036, Graz, Österreich

    R. Windhager

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  1. R. Windhager
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  2. A. Leithner
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  3. M. Hochegger
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Correspondence to R. Windhager.

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Windhager, R., Leithner, A. & Hochegger, M. Wechsel von Tumorendoprothesen des Kniegelenks. Orthopäde 35, 176–183 (2006). https://doi.org/10.1007/s00132-005-0913-7

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