Korim Muhammad T, Esler Colin N A, Reddy Venuthurla R M, Ashford Robert U
Leicester Orthopaedics, University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester LE5, United Kingdom.
Knee. 2013 Dec;20(6):367-75. doi: 10.1016/j.knee.2013.09.001. Epub 2013 Sep 20.
Endoprosthetic replacement (EPR) for limb salvage is an established treatment modality for orthopaedic malignancies around the knee. Increasingly, they are being used for non-tumour indications such as fractures, bone loss associated with aseptic loosening, septic loosening and ligament insufficiencies.
We reviewed the evolution and biomechanics of knee EPRs. MEDLINE was searched using the PubMed interface to identify relevant studies pertaining to the use of knee EPRs in non-tumour conditions. Failures, mortality and knee scores were the main outcome measures. Subgroup analysis in the non-tumour conditions was also performed.
There were nine studies with an average follow-up of 3.3years (Range 1-5years) describing 241 EPRs used in non-tumour conditions. Re-operation for any reason occurred in 17% (41/241) of cases. The most common complication was infection (15%) followed by aseptic loosening (5%) and periprosthetic fractures (5%). The mortality rate averaged 22%. Infected knee arthroplasties were less likely to have a successful outcome when salvaged with an EPR with failure rates up to 33%.
Endoprosthetic replacement is a limb salvage option when other surgical options are unfeasible, especially in low demand elderly patients with limited life expectancy. They have low rates of failure in the medium term.
Level 1.
用于保肢的人工关节置换术（EPR）是治疗膝关节周围骨科恶性肿瘤的一种既定治疗方式。越来越多地，它们被用于非肿瘤适应症，如骨折、与无菌性松动、感染性松动和韧带功能不全相关的骨丢失。
我们回顾了膝关节EPR的发展历程和生物力学。使用PubMed界面在MEDLINE中进行检索，以识别与膝关节EPR在非肿瘤情况下的使用相关的研究。失败率、死亡率和膝关节评分是主要的结局指标。还对非肿瘤情况下进行了亚组分析。
有9项研究，平均随访3.3年（范围1 - 5年），描述了241例在非肿瘤情况下使用的EPR。因任何原因进行再次手术的病例占17%（41/241）。最常见的并发症是感染（15%），其次是无菌性松动（5%）和假体周围骨折（5%）。死亡率平均为22%。当用EPR挽救感染性膝关节置换术时，成功结局的可能性较小，失败率高达33%。
当其他手术选择不可行时，人工关节置换术是一种保肢选择，特别是在预期寿命有限、需求较低的老年患者中。它们在中期的失败率较低。
1级。
