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Knee salvage in revision arthroplasty after massive bone loss of the femur condyles (≥Engh III) with a single-modular-hinged knee revision implant

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Massive bone loss of the femur condyles in revision arthroplasty often requires modular-hinged revision implants to restore a stable joint situation. In the present series, the outcome after knee revision surgery using a single modular-hinged revision implant in patients with severe bone defects (>Engh III) is investigated.

Methods

Sixty patients with severe bone defects (≥Engh III) after failed primary and revision knee arthroplasty were included. Medium follow-up was 47 (range 10–84) months after knee revision surgery. Medium patient age was 70 (range 33–87) years at the time of surgery. An average of 2.3 prior knee operations per patient was performed. 70 % of the patients required the knee revision implant after two-stage revision because of a deep implant infection.

Results

Estimated 5 year extremity survival was 95 and 65 % implant survival. Reasons for implant revision in decreasing order were reinfection (30 %), aseptic loosening (13 %), and periprosthetic fracture (9.8 %). The average active range of motion in the knee joint was 88° (range 40°–115°) for flexion. An extension deficit of a mean of −6° was (range −50–5° hyper-extension) observed. Patient age influenced the functional results significantly in terms of reduced walking distances and decreased modified WOMAC score.

Conclusion

In consideration of this complex study, population acceptable functional results can be achieved using a modular knee revision endoprosthesis. In younger patients (<60 years), satisfying results in terms of walking ability and overall satisfactory can be expected. The outcome in older multimorbid patients is worse. Yet, operation in these patients can be feasible to restore enough mobility for daily household activities.

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References

  1. Lee QJ, Mak WP, Wong YC (2015) Risk factors for periprosthetic joint infection in total knee arthroplasty. J Orthop Surg (Hong Kong) 23(3):282–286

    Google Scholar 

  2. Nikolaus OB, McLendon PB, Hanssen AD, Mabry TM, Berbari EF, Sierra RJ (2016) Factors associated with 20-year cumulative risk of infection after aseptic index revision total knee arthroplasty. J Arthroplasty 31(4):872–877. doi:10.1016/j.arth.2015.10.025

    Article  PubMed  Google Scholar 

  3. Kinkel S, Lehner B, Kleinhans JA, Jakubowitz E, Ewerbeck V, Heisel C (2010) Medium to long-term results after reconstruction of bone defects at the knee with tumor endoprostheses. J Surg Oncol 101(2):166–169. doi:10.1002/jso.21441

    CAS  PubMed  Google Scholar 

  4. Holl S, Schlomberg A, Gosheger G, Dieckmann R, Streitbuerger A, Schulz D, Hardes J (2012) Distal femur and proximal tibia replacement with megaprosthesis in revision knee arthroplasty: a limb-saving procedure. Knee Surg Sports Traumatol Arthrosc 20(12):2513–2518. doi:10.1007/s00167-012-1945-2

    Article  PubMed  Google Scholar 

  5. Engh GA, Ammeen DJ (1998) Periprosthetic fractures adjacent to total knee implants: treatment and clinical results. Instr Course Lect 47:437–448

    CAS  PubMed  Google Scholar 

  6. Engh GA, Ammeen DJ (1998) Classification and preoperative radiographic evaluation: knee. Orthop Clin North Am 29(2):205–217

    Article  CAS  PubMed  Google Scholar 

  7. Felix NA, Stuart MJ, Hanssen AD (1997) Periprosthetic fractures of the tibia associated with total knee arthroplasty. Clin Orthop Relat Res 345:113–124

    Article  PubMed  Google Scholar 

  8. Rorabeck CH, Taylor JW (1999) Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop Clin North Am 30(2):209–214

    Article  CAS  PubMed  Google Scholar 

  9. Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36(5):309–332. doi:10.1016/j.ajic.2008.03.002

    Article  PubMed  Google Scholar 

  10. Panegrossi G, Ceretti M, Papalia M, Casella F, Favetti F, Falez F (2014) Bone loss management in total knee revision surgery. Int Orthop 38(2):419–427. doi:10.1007/s00264-013-2262-1

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kuchinad R, Fourman MS, Fragomen AT, Rozbruch SR (2014) Knee arthrodesis as limb salvage for complex failures of total knee arthroplasty. J Arthroplasty 29(11):2150–2155. doi:10.1016/j.arth.2014.06.021

    Article  PubMed  Google Scholar 

  12. Angelini A, Henderson E, Trovarelli G, Ruggieri P (2013) Is there a role for knee arthrodesis with modular endoprostheses for tumor and revision of failed endoprostheses? Clin Orthop Relat Res 471(10):3326–3335. doi:10.1007/s11999-013-3067-7

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bauman RD, Lewallen DG, Hanssen AD (2009) Limitations of structural allograft in revision total knee arthroplasty. Clin Orthop Relat Res 467(3):818–824. doi:10.1007/s11999-008-0679-4

    Article  PubMed  PubMed Central  Google Scholar 

  14. Richards CJ, Garbuz DS, Pugh L, Masri BA (2011) Revision total knee arthroplasty: clinical outcome comparison with and without the use of femoral head structural allograft. J Arthroplasty 26(8):1299–1304. doi:10.1016/j.arth.2010.12.003

    Article  PubMed  Google Scholar 

  15. Back DL, David L, Hilton A, Blunn G, Briggs TW, Cannon SR (2008) The SMILES prosthesis in salvage revision knee surgery. Knee 15(1):40–44. doi:10.1016/j.knee.2007.09.002

    Article  CAS  PubMed  Google Scholar 

  16. Westrich GH, Mollano AV, Sculco TP, Buly RL, Laskin RS, Windsor R (2000) Rotating hinge total knee arthroplasty in severly affected knees. Clin Orthop Relat Res 379:195–208

    Article  PubMed  Google Scholar 

  17. Springer BD, Hanssen AD, Sim FH, Lewallen DG (2001) The kinematic rotating hinge prosthesis for complex knee arthroplasty. Clin Orthop Relat Res 392:283–291

    Article  PubMed  Google Scholar 

  18. Gosheger G, Gebert C, Ahrens H, Streitbuerger A, Winkelmann W, Hardes J (2006) Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res 450:164–171. doi:10.1097/01.blo.0000223978.36831.39

    Article  PubMed  Google Scholar 

  19. Kawai A, Muschler GF, Lane JM, Otis JC, Healey JH (1998) Prosthetic knee replacement after resection of a malignant tumor of the distal part of the femur. Medium to long-term results. J Bone Joint Surg Am 80(5):636–647

    CAS  PubMed  Google Scholar 

  20. Jeys LM, Grimer RJ, Carter SR, Tillman RM (2005) Periprosthetic infection in patients treated for an orthopaedic oncological condition. J Bone Joint Surg Am 87(4):842–849. doi:10.2106/JBJS.C.01222

    Article  CAS  PubMed  Google Scholar 

  21. Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, Windhager R, Kotz RI, Mercuri M, Funovics PT, Hornicek FJ, Temple HT, Ruggieri P, Letson GD (2011) Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am 93(5):418–429. doi:10.2106/JBJS.J.00834

    Article  PubMed  Google Scholar 

  22. Tigani D, Trisolino G, Fosco M, Ben Ayad R, Costigliola P (2013) Two-stage reimplantation for periprosthetic knee infection: influence of host health status and infecting microorganism. Knee 20(1):9–18. doi:10.1016/j.knee.2012.06.004

    Article  CAS  PubMed  Google Scholar 

  23. Sanguineti F, Mangano T, Formica M, Franchin F (2014) Total knee arthroplasty with rotating-hinge Endo-Model prosthesis: clinical results in complex primary and revision surgery. Arch Orthop Trauma Surg 134(11):1601–1607

    Article  CAS  PubMed  Google Scholar 

  24. Zimmerli W, Moser C (2012) Pathogenesis and treatment concepts of orthopaedic biofilm infections. FEMS Immunol Med Microbiol 65(2):158–168. doi:10.1111/j.1574-695X.2012.00938.x

    Article  CAS  PubMed  Google Scholar 

  25. Janz V, Wassilew GI, Kribus M, Trampuz A, Perka C (2015) Improved identification of polymicrobial infection in total knee arthroplasty through sonicate fluid cultures. Arch Orthop Trauma Surg 135(10):1453–1457

    Article  CAS  PubMed  Google Scholar 

  26. Hoell S, Moeller A, Gosheger G, Hardes J, Dieckmann R, Schulz D (2016) Two-stage revision arthroplasty for periprosthetic joint infections: what is the value of cultures and white cell count in synovial fluid and CRP in serum before second stage reimplantation? Arch Orthop Trauma Surg 136(4):447–452

    Article  PubMed  Google Scholar 

  27. Myers GJ, Abudu AT, Carter SR, Tillman RM, Grimer RJ (2007) Endoprosthetic replacement of the distal femur for bone tumours: long-term results. J Bone Joint Surg Br 89(4):521–526. doi:10.1302/0301-620X.89B4.18631

    Article  CAS  PubMed  Google Scholar 

  28. Singh JA, Gabriel S, Lewallen D (2008) The impact of gender, age, and preoperative pain severity on pain after TKA. Clin Orthop Relat Res 466(11):2717–2723. doi:10.1007/s11999-008-0399-9

    Article  PubMed  PubMed Central  Google Scholar 

  29. Steckel HKHM, Baums MH, Schultz W (2005) Long-term results of the blauth knee prosthesis- current status of hinged knee prosthesis. Z Orthop 143:30–35. doi:10.1055/s-2004-832404

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, NRW, Germany

    Arne Streitbuerger, Jendrik Hardes, Georg Gosheger & Ralf Dieckmann

  2. Department of Orthopedics, Paracelsus-Klink Osnabrück, Osnabrück, Germany

    Steffen Hoell

Authors
  1. Arne Streitbuerger
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  2. Jendrik Hardes
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  3. Georg Gosheger
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  4. Ralf Dieckmann
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  5. Steffen Hoell
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Correspondence to Arne Streitbuerger.

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Streitbuerger, A., Hardes, J., Gosheger, G. et al. Knee salvage in revision arthroplasty after massive bone loss of the femur condyles (≥Engh III) with a single-modular-hinged knee revision implant. Arch Orthop Trauma Surg 136, 1077–1083 (2016). https://doi.org/10.1007/s00402-016-2491-z

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  • DOI: https://doi.org/10.1007/s00402-016-2491-z

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