gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie
74. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie
96. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie
51. Tagung des Berufsverbandes der Fachärzte für Orthopädie und Unfallchirurgie

26. - 29.10.2010, Berlin

Reconstruction of the extensor mechanism with an alloplastic patellar ligament after resection of the proximal tibia in tumor and revision arthroplasty: clinical results after a mean follow-up of 8 years

Meeting Abstract

  • H. Gollwitzer - Klinik für Orthopädie und Unfallchirurgie der TU München, Sektion Endoprothetik u. rek. Hüft- und Kniegelenkschirurgie, München, Germany
  • L. Gerdesmeyer - Mare Klinikum Kiel, Institut für Klinische Forschung, Kiel, Germany
  • R. von Eisenhart-Rothe - TU München, Klinikum rechts der Isar der, Klinik für Orthopädie und Unfallchirurgie, München, Germany
  • U. Saur - Klinik für Orthopädie und Unfallchirurgie der TU München, Germany
  • H. Pilge - Klinikum rechts der Isar, TU München, Klinik für Orthopädie und Unfallchirurgie, Technische Universität München, München, Germany
  • R. Gradinger - TU München, Klinikum rechts der Isar, Klinik für Orthopädie und Unfallchirurgie, München, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie. 74. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 96. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 51. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 26.-29.10.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocIN21-1052

DOI: 10.3205/10dkou128, URN: urn:nbn:de:0183-10dkou1284

Veröffentlicht: 21. Oktober 2010

© 2010 Gollwitzer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Resection of the proximal tibia in tumor and revision arthroplasty often results in limited knee function and extensor lag. Aim of the present study was the evaluation of survival and function of a novel alloplastic patellar ligament reconstruction (Trevira cord) directly fixed to a proximal tibial megaprosthesis.

Methods: A total of 11 consecutive patients requiring resection of the proximal tibia were enrolled in this prospective study. Extensor mechanism was reconstructed with an alloplastic patellar ligament (Trevira cord) directly fixed to a proximal tibial replacement after knee arthroplasty with a megaprosthesis. Pain, knee function and patient satisfaction were assessed at follow-up.

Results and conclusions: Mean age at the time of operation was 37 years [16–69]. Underlying reasons for proximal tibial resection were malignant bone tumors in 10 cases (7 osteosarcomas, 1 chondrosarcoma, and 2 metastases) and revision arthroplasty with extensive bone loss in 1 case. 98 months [81–137] after surgery, 8 of the initially operated 11 patients were available for follow-up. 3 patients with malignant tumors (1 osteosarcoma and 2 metastasis of the proximal tibia) had died with the prosthesis in place.

Two patients suffered an infection, which resulted in an amputation in 1 patient and limb salvage with a stiff knee after multiple revisions in another patient. Reported revisions were due to mechanical problems with the implanted megaprothesis (e.g. aseptic loosening), but no revision of the extensor mechanism and Trevira cord was necessary. Active range of motion was 83±30°, with an average extensor lag of 3±4°. American knee society score reached 81±9 out of a possible maximum of 100 points, and Oxford knee score averaged 35±11 points out of a possible maximum of 48 points. Pain during walking as assessed by a 10-point visual analogue scale improved from 6 [3–10] before the operation to 2 [0–5] at the time of follow-up. No patient reported peri- or retropatellar pain.

Patient satisfaction was reported to be very good in 3, good in 3 and fair in 1 patient. 6 patients were able to work.

Alloplastic reconstruction of the patellar ligament after proximal tibial resection proved a promising option for tumor and revision arthroplasty resulting in good function and high patient satisfaction. Function was superior compared to most other published reconstruction methods after patellar ligament resection (e.g. gastrocnemius transfer).