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Der Spacer an der oberen Extremität: Indikationen und technische Umsetzung

Spacer in the upper extremity: indications and technical implementation

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Zusammenfassung

Die kontinuierlich steigenden Zahlen primär implantierter Schulter- und Ellenbogenprothesen werden von einer Vielzahl neuer Materialkombinationen und modifizierten Implantationstechniken begleitet, damit ist auch ein Anstieg der Revisionseingriffe verbunden. Die chirurgische Sanierung postoperativer Komplikationen, insbesondere bei periprothetischen Infektionen, stellt enorme technische Anforderungen an das gesamte chirurgische Team. Die Anwendung antibiotikabeladener Zementspacer hat sich bei der Sanierung dieser komplexen Fälle etabliert. Die Erfahrungen zweizeitiger Prothesenwechsel aus Hüft- und Knieendoprothetik konnten auch erfolgreich in der Chirurgie der oberen Extremität Anwendung finden. Die Vorteile des zweizeitigen Einsatzes antibiotikabeladener Interimsprothesen liegen im hohen lokalen Antibiotikaspiegel und der oft zuverlässigen Eradikation periprothetischer Low-Grade-Infektionen bei Biofilm-bildenden Keimen. Demgegenüber stehen häufig die höheren Komplikationsraten und längeren Behandlungszeiten. Der vorliegende Artikel soll einen Überblick zur Indikationsstellung, technischen Umsetzung, klinischen Ergebnissen, Komplikationen und Beispielanwendungen temporärer Interimsprothese geben.

Abstract

The continuously increasing number of primarily implanted shoulder and elbow prostheses is accompanied by a large number of new material combinations and modified implantation techniques. However, this is also associated with an increase in revision interventions. Surgical treatment of postoperative complications, particularly in the case of periprosthetic infections, places enormous technical demands on the entire surgical team. The use of antibiotic-loaded cement spacers has become established in the treatment of these complex cases. The experience of two-stage prosthesis replacement from hip and knee endoprosthetics has also been successfully applied in surgery of the upper extremities. Advantages of two-stage therapy using antibiotic-loaded interim prostheses include the high local antibiotic level and reliable eradication of periprosthetic low-grade infections with biofilm-forming bacteria. However, the two-stage technique is associated with a high complication rate and longer treatment time. This article provides an overview of indications, technical implementation, clinical results, complications, and example applications of temporary interim prostheses.

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Authors and Affiliations

  1. Klinik für Orthopädie, Unfallchirurgie, Schulter und Endoprothetik, Rhön-Klinikum Campus Bad Neustadt, von-Guttenberg-Str. 11, 97616, Bad Neustadt, Deutschland

    Konrad Malachowski, Frank Gohlke, Ayman A. Abdelkawi & Arne Berner

  2. Department of Orthopaedics and Traumatology, University of Assiut, Assiut, Egypt

    Ayman A. Abdelkawi

  3. ATOS Klinik Fleetinsel Hamburg, Hamburg, Deutschland

    Robert Hudek

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  1. Konrad Malachowski
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Correspondence to Konrad Malachowski.

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Interessenkonflikt

K. Malachowski, A.A. Abdelkawi, A. Berner und R. Hudek geben an, dass kein Interessenkonflikt besteht. F. Gohlke ist als Consultant für Stryker/Wright/Tornier tätig und Entwickler eines Revisionssystems von Wright – ohne „Royalties“ anzunehmen.

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

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Das online verfügbare Video zeigt die Anfertigung eines Ellenbogenspacers

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Malachowski, K., Gohlke, F., Abdelkawi, A.A. et al. Der Spacer an der oberen Extremität: Indikationen und technische Umsetzung. Obere Extremität 18, 88–96 (2023). https://doi.org/10.1007/s11678-023-00735-x

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