T Pfitzner1,2, T Engelhardt1,2, A Kunitz3, I Melcher1, P Schwabe4,5. 1. Zentrum für Muskuloskeletale Tumormedizin - Vivantes Sarkomzentrum im Department für Bewegungschirurgie, Vivantes Klinikum Spandau, Neue Bergstraße 6, 13585, Berlin, Deutschland. 2. Klinik für Endoprothetik, Knie- und Hüftchirurgie im Department für Bewegungschirurgie, Vivantes Klinikum Spandau, Berlin, Deutschland. 3. Klinik für Innere Medizin - Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Spandau, Berlin, Deutschland. 4. Zentrum für Muskuloskeletale Tumormedizin - Vivantes Sarkomzentrum im Department für Bewegungschirurgie, Vivantes Klinikum Spandau, Neue Bergstraße 6, 13585, Berlin, Deutschland. Philipp.Schwabe@vivantes.de. 5. Klinik für Endoprothetik, Knie- und Hüftchirurgie im Department für Bewegungschirurgie, Vivantes Klinikum Spandau, Berlin, Deutschland. Philipp.Schwabe@vivantes.de.
Abstract
BACKGROUND: The good functional outcomes of endoprosthetic knee reconstructions combined with modern oncosurgical concepts have resulted in a decreased rate of primary amputations following tumor resection in the region of the knee, thereby improving the quality of life of affected patients. OBJECTIVE: This study aimed to reappraise complications which are more common than in conventional arthroplasties performed for arthritis or trauma due to the complexity of the surgical procedures, the size of the endoprosthetic reconstructions, and neo-/adjuvant therapies. MATERIAL AND METHODS: Possible intra- and postoperative complications and treatment options are presented. RESULTS: Typical intraoperative complications include malalignment (axis, length, rotation) in implant positioning, unplanned soft tissue defects, impaired implant fixation due to poor bone stock, periprosthetic fractures, vessel/nerve injuries, and lesions/defects of the extensor mechanism. The relevant postoperative complication profile is characterized by local recurrences, periprosthetic infections, thromboembolic events, and mechanical failures (loosening, failure of the constraining mechanism). CONCLUSION: Depending on anatomic conditions and the systemic oncological status of the patient, these complications represent tremendous challenges to reconstructive management. Knowledge of the potential problems enables them to be avoided. This requires profound experience in oncosurgery and tumor endoprosthesis revisions.
BACKGROUND: The good functional outcomes of endoprosthetic knee reconstructions combined with modern oncosurgical concepts have resulted in a decreased rate of primary amputations following tumor resection in the region of the knee, thereby improving the quality of life of affected patients. OBJECTIVE: This study aimed to reappraise complications which are more common than in conventional arthroplasties performed for arthritis or trauma due to the complexity of the surgical procedures, the size of the endoprosthetic reconstructions, and neo-/adjuvant therapies. MATERIAL AND METHODS: Possible intra- and postoperative complications and treatment options are presented. RESULTS: Typical intraoperative complications include malalignment (axis, length, rotation) in implant positioning, unplanned soft tissue defects, impaired implant fixation due to poor bone stock, periprosthetic fractures, vessel/nerve injuries, and lesions/defects of the extensor mechanism. The relevant postoperative complication profile is characterized by local recurrences, periprosthetic infections, thromboembolic events, and mechanical failures (loosening, failure of the constraining mechanism). CONCLUSION: Depending on anatomic conditions and the systemic oncological status of the patient, these complications represent tremendous challenges to reconstructive management. Knowledge of the potential problems enables them to be avoided. This requires profound experience in oncosurgery and tumor endoprosthesis revisions.
Authors: Paul G Fairhurst; Thomas R Wyss; Salome Weiss; Daniel Becker; Juerg Schmidli; Vladimir Makaloski Journal: Knee Date: 2018-06-29 Impact factor: 2.199