Zusammenfassung
Hintergrund
Megaprothesen finden zunehmende Anwendung nach knöcherner Segmentresektion bei Knochensarkomen, Skelettmetastasen und bei ausgedehnten knöchernen Defekten in der Revisionsendoprothetik.
Fragestellung
Beschreibung der Inzidenz der häufigsten Komplikationen in der Megaprothetik. Darstellung des Komplikationsmanagements mitsamt Therapieempfehlungen.
Material und Methoden
Es erfolgte eine selektive Literaturrecherche sowie das Einbringen eigener Erfahrungen zur Darstellung aktueller Erkenntnisse auf dem Gebiet des Komplikationsmanagements in der Megaprothetik.
Ergebnisse
Prospektiv-randomisierte Studien oder Metaanalysen fehlen zu diesem Thema. Die Literaturrecherche zeigt dennoch, dass neben dem Lokalrezidiv die periprothetische Infektion die gravierendste Komplikation darstellt. Der zweizeitige Prothesenwechsel ist weiterhin als Goldstandard zu betrachten, auch wenn in ausgesuchten Fällen ein einzeitiger Wechsel unter Belassung der Prothesenschäfte gerechtfertigt erscheint. Die periprothetische Infektion ist jedoch weiterhin mit einem nicht unerheblichen Risiko der sekundären Amputation vergesellschaftet. Mechanische Komplikationen wie der Verschleiß des Gelenkmechanismus bei megaprothetischem Ersatz des Kniegelenks und die aseptische Schaftlockerung sind in der Regel extremitätenerhaltend therapierbar. Eine Luxation eines proximalen Femurersatzes stellt bei Verwendung eines bi- oder tripolaren Pfannensystems die Ausnahme dar.
Schlussfolgerungen
Komplikationen in der Megaprothetik sind in den meisten Fällen durch Revisionsoperationen zu beherrschen.
Abstract
Background
Megaprostheses are frequently used after segmental resection of bone sarcomas, bone metastases, and in large osseous defects in revision arthroplasty.
Objectives
The incidence of the most common complications associated the use of megaprostheses are reported. The management of complications including therapeutic recommendations are described.
Materials and methods
The current knowledge and our own experience of complication management with the use of megaprostheses are presented.
Results
Prospective, randomized studies or meta-analyses on this topic are lacking. An analysis of the literature shows that beside the occurrence of a local recurrence, periprosthetic infection remains the most serious complication. Two-stage revision remains the gold standard, but a single-stage exchange of the prosthesis without removing the stems might be possible in selected cases. Infection is associated with a higher risk of secondary amputation. In contrast, mechanical failures (e.g., wear of the bushings in knee replacements and aseptic loosening of the stems) can be treated more easily. Dislocation of a proximal femur replacement can mostly be prevented by using bi- or tripolar cups.
Conclusions
Complications with the use of megaprostheses can be successfully treated by revision surgery in most cases.
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Interessenkonflikt. J. Hardes, H. Ahrens, G. Gosheger, M. Nottrott, R. Dieckmann, M.-P. Henrichs und A. Streitbürger geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Hardes, J., Ahrens, H., Gosheger, G. et al. Komplikationsmanagement bei Megaprothesen. Unfallchirurg 117, 607–613 (2014). https://doi.org/10.1007/s00113-013-2477-z
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DOI: https://doi.org/10.1007/s00113-013-2477-z