[Transcutaneous osseointegrated prostheses systems (TOPS) for rehabilitation following limb loss : Surgical approach for necessary removal of the implant].
Horst-Heinrich Aschoff, Marko Sass, Thomas Mittlmeier
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引用次数: 0
Abstract
Objective: Removal of a transcutaneous osseintegrated endo-fix stem (ESKA Orthopaedic, Lübeck, Germany) following a fatigue fracture of the implant, whilst protecting the residual femur bone to allow transcutaneous osseointegrated prosthesis system (TOPS) reimplantation.
Indications: A patient's request for a further TOPS implantation following a fatigue fracture of a circular osseointegrated implant stem.
Contraindications: Impending destruction of the bone tube through mobilisation of the femoral implant stem with insufficient thickness of the cortical wall (< 2-3 mm). This fact has to be considered before providing the indication for implant replacement.
Surgical technique: A fatigue fracture of a circular osseointegrated implant stem is generally associated with difficult removal of the implant. The longitudinal osteotomy of the tubular femur would lead to massive destruction of the bone due to the osseointegration of the corticalis into the three-dimensional structured surface of the implant and must be excluded as an option for removal. Therefore, the implant must be mobilized from the distal end of the bone. For this approach, tubular cutters and shock wave chisels are available. The procedure itself is time-consuming and is accompanied by a weakening of the corticalis of the femur bone. Intraoperative smear tests to prove a bacteria-free intramedullary space are obligatory.
Postoperative management: After successful removal of an endo-fix stem, reassembling of a new TOPS implant should be considered 4-6 weeks later after ensuring the absence of bacterial colonization of the intramedullary space. If bacteria are detected, surgical revision is necessary.
Results: The authors experience with the described removal of the implant with 4 patients over a period of 17 years must be regarded as anecdotal. All 4 patients could be successfully re-implanted, which emphasizes the value of the described method.
期刊介绍：
Orthopedics and Traumatology is directed toward all orthopedic surgeons, trauma-tologists, hand surgeons, specialists in sports injuries, orthopedics and rheumatology as well as gene-al surgeons who require access to reliable information on current operative methods to ensure the quality of patient advice, preoperative planning, and postoperative care.
The journal presents established and new operative procedures in uniformly structured and extensively illustrated contributions. All aspects are presented step-by-step from indications, contraindications, patient education, and preparation of the operation right through to postoperative care. The advantages and disadvantages, possible complications, deficiencies and risks of the methods as well as significant results with their evaluation criteria are discussed. To allow the reader to assess the outcome, results are detailed and based on internationally recognized scoring systems.
Orthopedics and Traumatology facilitates effective advancement and further education for all those active in both special and conservative fields of orthopedics, traumatology, and general surgery, offers sup-port for therapeutic decision-making, and provides – more than 30 years after its first publication – constantly expanding and up-to-date teaching on operative techniques.
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