[Transcutaneous osseointegrated prostheses systems (TOPS) for rehabilitation following limb loss : Surgical approach for necessary removal of the implant].

IF 1 4区医学 Q3 ORTHOPEDICS Operative Orthopadie Und Traumatologie Pub Date : 2025-04-01 Epub Date: 2025-01-23 DOI:10.1007/s00064-024-00883-5

Horst-Heinrich Aschoff, Marko Sass, Thomas Mittlmeier

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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.

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[经皮骨整合假体系统（TOPS）用于肢体丧失后的康复：必要的植入物移除的手术方法]。

目的：在假体疲劳骨折后取出经皮骨整合内固定干（ESKA Orthopaedic, l beck, Germany），同时保护残余股骨，允许经皮骨整合假体系统（TOPS）再植。适应症：圆形骨整合种植体茎疲劳骨折后，患者要求进一步进行TOPS植入。禁忌症：在皮质壁厚度不足的情况下，通过股骨植入物柄的活动可能会破坏骨管(手术技术：圆形骨整合植入物柄的疲劳骨折通常与难以取出植入物有关。管状股骨的纵向截骨会导致皮质骨与种植体的三维结构表面的骨融合而导致骨的大量破坏，必须排除作为移除的选择。因此，种植体必须从骨的远端移动。对于这种方法，可以使用管状切削齿和冲击波凿子。手术本身很耗时，并且伴随着股骨皮质的弱化。术中涂片检查证明髓内间隙无细菌是必须的。术后处理：在成功取出内固定柄后，在确保髓内间隙没有细菌定植后4-6周后考虑重新组装新的TOPS种植体。如果检测到细菌，则需要手术修复。结果：作者在17年的时间里与4名患者进行了所描述的植入物移除的经历必须被视为轶事。4例患者均能成功再植，说明了该方法的价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Operative Orthopadie Und Traumatologie ORTHOPEDICS-

CiteScore

2.10

自引率

0.00%

发文量

审稿时长

>12 weeks

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.