Windhager R, Leithner A, Hochegger M
Klinik für Orthopädie, Medizinische Universität, Graz, Osterreich.
Orthopade. 2006 Feb;35(2):176-83. doi: 10.1007/s00132-005-0913-7.
Revision of tumour endoprostheses around the knee joint is mainly caused by aseptic loosening and deep infection. Mechanical complications have been significantly reduced by improvements in prosthetic design. The rate of aseptic loosening after distal femur or proximal tibia replacement ranges from 10% to 45% depending on the time of follow-up and prosthetic design; the success rate after revision averages 75% at midterm follow-up. The rate of infection reported in the literature varies between 2.9% and 12%. One stage revision may be considered after acute infection without signs of loosening, after which a success rate of 77.8% can be expected. Two stage revision is mainly indicated in multi-resistant microorganisms as well as septic loosening, with a success rate of 75% after 5 years. Deep infection represents the most serious complication in long-term follow-up, often leading to amputation due to soft tissue problems after tumour resection. The authors were able to confirm the minimal decrease in MSTS score despite the large number of operations (15 patients: nine females, six males; median MSTS score 84%; mean 81%).
膝关节周围肿瘤人工关节翻修主要由无菌性松动和深部感染引起。假体设计的改进已显著减少了机械并发症。根据随访时间和假体设计，股骨远端或胫骨近端置换术后无菌性松动率在10%至45%之间；翻修术后中期随访的成功率平均为75%。文献报道的感染率在2.9%至12%之间。对于无松动迹象的急性感染，可考虑一期翻修，术后成功率预计为77.8%。二期翻修主要适用于多重耐药微生物感染以及感染性松动，5年后成功率为75%。深部感染是长期随访中最严重的并发症，肿瘤切除后常因软组织问题导致截肢。尽管手术量很大（15例患者：9例女性，6例男性；MSTS评分中位数84%，平均81%），作者仍能证实MSTS评分仅有轻微下降。
