From the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
J Am Acad Orthop Surg. 2021 Aug 1;29(15):e743-e759. doi: 10.5435/JAAOS-D-20-01052.
Megaprostheses as a means of limb salvage originated in orthopaedic oncology, and implant evolution was initially driven by developments within this field. Improvements in imaging modalities and in chemotherapeutics prolonged patient survival and promoted a transformation in the surgeon's mentality from salvage operation to functional limb reconstruction. As primary arthroplasty operations became more popular, megaprostheses found new utility in hip and knee revision arthroplasty. In this capacity, these implants provided much needed alternatives to traditional arthroplasty revision options for addressing massive bone loss and complex periprosthetic fractures. The indications for megaprostheses continue to expand with advances in design, stability, and overall longevity. Thus, greater numbers of orthopaedic surgeons in arthroplasty and traumatology have to be familiar with this technology. Importantly, each anatomic location presents unique considerations for reconstruction; however, additional variables such as the quantity of bone loss, the quality of remaining bone stock, and fracture type also influence implant selection. Ultimately, there is still much to be optimized in the use of megaprostheses for hip and knee revision arthroplasty. High multifactorial complication and revision surgery rates compared with conventional prostheses make these implants for many a "last resort" option.
假体作为保肢手段起源于骨肿瘤学，植入物的发展最初是由该领域的发展驱动的。影像学技术和化疗药物的改进延长了患者的生存时间，并促使外科医生的心态从保肢手术转变为功能性肢体重建。随着原发性关节置换手术变得更加流行，假体在髋关节和膝关节翻修中找到了新的用途。在这种情况下，这些植入物为解决大量骨丢失和复杂假体周围骨折提供了急需的传统关节置换翻修选择。随着设计、稳定性和整体寿命的进步，假体的适应证不断扩大。因此，越来越多的关节置换和创伤骨科的骨科医生必须熟悉这项技术。重要的是，每个解剖部位的重建都有独特的考虑因素；然而，其他变量，如骨丢失的数量、剩余骨量的质量和骨折类型，也会影响植入物的选择。最终，在髋关节和膝关节翻修中使用假体还有很多需要优化的地方。与传统假体相比，假体的多因素并发症和翻修手术率较高，使得这些假体成为许多人的“最后选择”。
