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Megaprothesen in der Knierevision

Mega-prostheses in revision knee arthroplasty

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Zusammenfassung

Hintergrund

Aufgrund der steigenden Zahl an primären Knie-TEP-Implantationen wird die Revisionsendoprothetik in den nächsten Jahren stetig an Bedeutung gewinnen. Infolge dieser Entwicklung werden auch multiple Revisionen, insbesondere bei jungen Patienten, zunehmen. Die meist nicht vermeidbaren und bei jeder Revision größer werdenden knöchernen und auch weichteiligen Defekte werden den zunehmenden Einsatz auch von Megaimplantaten in Zukunft unverzichtbar machen.

Komplikationen

Die Implantation einer Megaprothese muss jedoch sorgfältig abgewogen und geplant werden, da insbesondere diese Implantate mit einem deutlich erhöhten Risiko für Infektionen und Lockerungen vergesellschaftet sind. Mechanische Komplikationen, patientenspezifische Komplikationen und periprothetische Infektionen können sowohl Ursache als auch Folge einer Revision eines Megaimplantates sein. Im Fall einer schweren Komplikation ist daher oft nur eine Salvage-Prozedur im Sinne einer Arthrodese, Amputation oder ggf. eine dauerhafte Fistelanlage möglich.

Abstract

Background

Due to a predicted increase in primary total knee arthroplasty (TKA), revision TKA will gain importance over the following years. Because the average age of patients receiving a TKA is decreasing the possible need for multiple revisions might increase as well. Despite efforts to minimize bone and soft tissue damage, the resulting bone and soft-tissue loss increases with each revision and will make the use of megaprostheses indispensable in the future.

Complications

The implantation of a mega-prosthesis must be carefully considered and planned, since mega-prostheses in particular are associated with an increased risk of infection and loosening. Mechanical complications, patient-specific problems and periprosthetic infections can be either the cause for or the result of revision surgery of a mega-prosthesis. In the case of a complication, only a salvage procedure, namely an arthrodesis, amputation or—if necessary—the installation of a permanent fistula is commonly recommended.

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Abbreviations

AORI:

Anderson Orthopedic Research Institut

TEP:

Totalendoprothese

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Authors and Affiliations

  1. Klinik König-Ludwig-Haus Würzburg, Lehrstuhl für Orthopädie, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland

    D. Rak, M. Weißenberger, K. Horas, S. von Hertzberg-Bölch &  M. Rudert

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  1. D. Rak
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  2. M. Weißenberger
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  3. K. Horas
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  4. S. von Hertzberg-Bölch
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Correspondence to M. Rudert.

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Interessenkonflikt

D. Rak, M. Weißenberger, K. Horas, S. von Hertzberg-Bölch und M. Rudert geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Rak, D., Weißenberger, M., Horas, K. et al. Megaprothesen in der Knierevision. Orthopäde 50, 1011–1017 (2021). https://doi.org/10.1007/s00132-021-04187-5

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