Gathen M, Schmolders J, Wimmer M D, Gravius N, Randau T M, Gravius S, Friedrich M
Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland.
Orthopaedic and Trauma Surgery Centre, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Deutschland.
Oper Orthop Traumatol. 2020 Feb;32(1):58-72. doi: 10.1007/s00064-019-0605-9. Epub 2019 Jun 26.
Restoration of a painless, weight-bearing extremity with a modular knee arthrodesis system based on a cementless modular revision stem for rotationally stable, diaphyseal anchorage.
Severe bone loss and compromised soft tissue after failed total knee arthroplasty, two-stage revisions and non-reconstructible knee extensor mechanism deficiency.
Extensive osteolysis preventing diaphyseal anchorage of the prosthesis. Contralateral arthrodesis of the knee joint and/or ipsilateral arthrodesis of the hip joint and contralateral lower extremity amputation.
In revision cases, removal of the total knee arthroplasty, spacer, the bone cement and all intramedullary granulation tissue. Reaming the medullary cavity with intramedullary reamers to cortical contact. Restoring leg length and rotation with trial implants. After implantation of the femoral and tibial stems, placing and tensioning of the rotationally aligned coupling elements.
Mobilization on two forearm crutches from postoperative day 1. Removal of the Redon drains after 48 h. Partial weight bearing of 20 kg for 6 weeks postoperatively. If plain radiographs show unchanged seating of the prosthesis after 6 weeks, loading can be increased by 10 kg per week until full weight bearing is achieved.
Between 2007 and 2012 clinical data were collected and analyzed retrospectively. A total of 27 patients had been treated within a two-stage exchange procedure with implantation of a modular intramedullary arthodesis nail TITAN (KAM-TITAN). The mean follow-up was 30.9 ± 12.0 months. A functional evaluation was performed using the Oxford Knee Score (OKS). The analyzed patients showed a mean score of 39.2 ± 8.3. To determine the pain level the Visual Analog Scale (VAS) for pain was used and showed a mean score of 2.9 ± 1.3. The rate of definitely free of infection (using Laffer criteria) at last follow-up was 85.2%.
使用基于非骨水泥模块化翻修柄的模块化膝关节融合系统，恢复无痛、可负重的肢体，实现骨干的旋转稳定固定。
全膝关节置换失败后严重骨丢失和软组织受损、二期翻修以及不可重建的膝关节伸肌机制缺陷。
广泛骨溶解，妨碍假体骨干固定。对侧膝关节融合和/或同侧髋关节融合以及对侧下肢截肢。
在翻修病例中，移除全膝关节置换物、间隔物、骨水泥和所有髓内肉芽组织。用髓内扩孔钻扩髓腔至皮质接触。使用试验植入物恢复肢体长度和旋转。植入股骨和胫骨干后，放置并张紧旋转对齐的连接元件。
术后第1天开始使用双前臂拐杖活动。48小时后拔除雷东引流管。术后6周部分负重20公斤。如果6周后X线平片显示假体位置无变化，可每周增加负重10公斤，直至完全负重。
回顾性收集并分析2007年至2012年的临床数据。共有27例患者接受了两期置换手术，植入了模块化髓内融合钉TITAN（KAM-TITAN）。平均随访时间为30.9±12.0个月。使用牛津膝关节评分（OKS）进行功能评估。分析的患者平均评分为39.2±8.3。使用疼痛视觉模拟量表（VAS）确定疼痛程度，平均评分为2.9±1.3。最后一次随访时明确无感染（使用拉弗标准）的比例为85.2%。
