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Einsatz eines modularen Knierevisionssystems MML im Rahmen des Knieprothesenwechsels und der Tumorendoprothetik

The modular MML revision system in knee revision and tumor arthroplasty

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Zusammenfassung

Zunehmendes Alter und höhere Mobilität der Patienten führen zu einer starken Zunahme der Wechseloperationen in der Kniegelenkendoprothetik. Modulare Prothesensysteme ermöglichen dabei immer komplexere Rekonstruktionen von Knochen-, Weichteil- und Streckapparatdefekten, wie sie bei Prothesenwechseloperationen oder Tumorresektionen auftreten können. Dabei stellt der Verlust der tibialen Insertionsstelle ein erhebliches chirurgisch-technisches Problem für den Streckapparat dar.

Die Verwendung des modularen Knieprothesenrevisionssystems MML bietet hier flexible Rekonstruktionsmöglichkeiten und spezielle technische Lösungen, sodass sichere Refixationen an der tibialen Komponente möglich sind. In der vorliegenden Studie wurden 70 Patienten nach Implantation des modularen Prothesensystems MML nachuntersucht. Mit dem MML-System konnten sehr gute funktionelle Ergebnisse erreicht werden. Bei einer Nachbeobachtungszeit von durchschnittlich 7 Jahren ±28 Monate konnten auf dem Oxford Knee Score 32±13 Punkte erreicht werden. Ähnlich gute klinische Ergebnisse zeigten sich bei der Analyse des funktionellen Scores der American Knee Society (AKS-Score) mit 71±25 Punkten. Nach Rekonstruktion des Streckapparates zeigten sich vergleichbar gute Ergebnisse wie im Gesamtkollektiv. Die relativ hohe Rate an Revisionsoperationen war ausschließlich auf mechanische Komplikationen (Verschleiß, Lockerung) zurückzuführen.

Abstract

Increasing age and a higher level of mobility lead to an increasing incidence in revision arthroplasty after total knee replacement and tumor surgery. So far, the reconstruction of large defects in bony and soft tissue environments can be accomplished by the modern modular components of revision implants. The consecutive reconstruction of the extensor mechanism in extended revision has its own drawbacks and is often associated with significant functional limitations for the patient. Specially designed implants and methods are required to generate good functional results.

The modular knee revision system MML provides specific modifications of the tibial component for reconstruction of the extensor mechanism. Combined with artificial strips, an excellent functional outcome could be achieved. In this study, 70 patients were operated with the MML endoprosthesis in knee revision or tumor surgery. An excellent functional outcome could be determined. At 7 years after surgery, an average of 32±13 points was achieved on the Oxford Knee Score. The outcome measurement using the functional scoring system of the American Knee Society (AKS score) showed similarly good results with 71±25 points out of 100. A minor deficit of only 2° in active extension could be observed after reconstruction of the extensor mechanism. In conclusion, we have demonstrated that the MML modular revision system is appropriate for reconstruction of segmental bone defects.

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Authors and Affiliations

  1. Department Endoprothetik und Wirbelsäulenchirurgie der Klinik für Orthopädie und Unfallchirurgie, Mare-Klinikum, Eckernförder Straße 219, 24119, Kiel-Kronshagen

    L. Gerdesmeyer & H. Grundei

  2. Klinik für Orthopädie und Unfallchirurgie, Technische Universität München

    A. Töpfer & P. Diehl

  3. Orthopädische Universitätsklinik Rostock

    J. Kircher

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  1. L. Gerdesmeyer
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  2. A. Töpfer
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  3. J. Kircher
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  4. H. Grundei
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  5. P. Diehl
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Correspondence to L. Gerdesmeyer.

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Gerdesmeyer, L., Töpfer, A., Kircher, J. et al. Einsatz eines modularen Knierevisionssystems MML im Rahmen des Knieprothesenwechsels und der Tumorendoprothetik. Orthopäde 35, 975–981 (2006). https://doi.org/10.1007/s00132-006-0982-2

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