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ABSTRACT: Due to improved oncological therapeutic procedures with longer survival times, the stabilization of osteolyses and pathological fractures is gaining importance. The proximal femur is often affected by metastases. As femoral stability can be compromised by such bone lesions, stabilization as a palliative measure is indicated to restore function and relieve pain. Besides intramedullary osteosynthesis and endoprosthetic reconstruction, compound osteosynthesis is an alternative method for stabilization of the proximal femur. Between 1994 and 2004, 34 compound osteosyntheses were performed for a tumor-caused lesion compromising mechanical stability of the proximal femur. Of those cases, 22 double-plate compound osteosyntheses and 12 single-plate compound osteosyntheses were performed for 9 pathological fractures and 25 osteolyses. Both techniques provided good primary stability. The average survival time after compound osteosynthesis was 14.2 months (range, 0-72 months). Double-plate compound osteosyntheses showed a lower mechanical failure rate than single-plate compound osteosyntheses (14.3% vs 33.3%) and a higher survival probability after 5 years (76.4% vs 38.6%). No surgical revision was required due to perioperative complications in any case. We conclude that reliable stabilization of extensive osteolyses and pathological fractures of the proximal femur can be achieved with compound osteosynthesis. Our data suggest that double-plate compound osteosyntheses is a more favorable technique than single-plate compound osteosyntheses based on a lower rate of mechanical failure and higher survival probability.
Orthopedics 07/2009; 32(6):403. · 2.66 Impact Factor
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ABSTRACT: Zusammenfassung Operationsziel Wiederherstellung einer geraden Beinachse und schmerzfreien Gelenkfunktion. Indikationen Mediale oder laterale, auf eine Gelenkhlfte beschrnkte Arthrose mit Fehlstellung der Beinachse unter 20, bei der eine sog. Umstellungsosteotomie nicht in Frage kommt. Osteonekrose des medialen Femurkondylus (Morbus Ahlbck). Voraussetzung: Alter ber 60 Jahre. Kontraindikationen Panarthrose. Instabilitt des Kniegelenks (abgesehen von relativer Aufklappbarkeit wegen Knorpelschwunds). Polyarthritis. Systemische Gelenkerkrankung wie z. B. Hmophilie. Neuropathische Arthropathie. Starke Adipositas. Fehlstellung der Beinachse ber 20, Beugekontraktur ber 20. Operationstechnik Darstellung des Kniegelenks ber einen medianen Zugang. Horizontale Resektion des betroffenen Tibiaplateaus unter Erhalt der Kreuz- und Seitenbnder. Zurichtung des Femurkondylus zur Aufnahme des entsprechenden Prothesenteils. Einzementierung der Prothesenkomponenten in achsengerechter Position. Ergebnisse Retrospektive Studie an 149 Patienten (34 Mnner und 115 Frauen im Alter zwischen 62 und 86 Jahren), die in den Jahren 1986-1990 operiert wurden. Der Nachuntersuchungszeitraum betrug 8-12 Jahre, durchschnittlich 10,07 Jahre. 44 Patienten sind zwischenzeitlich an knieunabhngigen Erkrankungen gestorben. 23 Prothesen wurden aus unterschiedlichen Grnden gewechselt. Die Ergebnisse wurden bei 35 Patienten telefonisch erfragt, bei 45 nach klinischen und radiologischen Untersuchungen sowie nach dem HSS-Score festgestellt: Bei 80% der Patienten fanden sich sehr gute und gute, bei 7,5% mige und bei 12,5% schlechte Resultate. Hauptgrnde fr die schlechten Ergebnisse waren ungnstige Ausgangssituationen wie z. B. rheumatische Polyarthritis, zu weit fortgeschrittene Gonarthrose, Lockerung oder Einsinken der tibialen Prothesenkomponente. Die berlebensrate ("survival rate") betrug bei 84 Patienten nach mehr als 10-jhriger Laufzeit und Revisionserfordernis als Endpunkt 83,7%. Abstract Objectives Correction of axial malalignment and restoration of a normal pain-free joint function through insertion of a unicompartmental runner. Indications Medial or lateral unicompartmental osteoarthritis. Osteonecrosis of the medial femoral condyle. Age over 60 years. Contraindications Osteoarthritis of more than one compartment. Ligamentous instability (instability due to cartilage loss is not a contraindication). Rheumatoid arthritis. Chronic synovitis. Systemic affections of joints (i. e., hemophilia). Neuropathic joint diseases. Obesity. Axial malalignment exceeding 20. Flexion contracture exceeding 20. Sugical Technique Medial approach. After visual confirmation that only one compartment is affected, resection of the tibial plateau while preserving cruciate and collateral ligaments. Preparation of the femoral condyle and restoration of axial alignment through insertion of the unicompartmental components. Avoid overcorrection. Results Between 1986 and 1990 a unicompartmental arthroplasty was done in 34 men and 115 women (62-86 years). 44 had died for unrelated reasons. 35 answered a questionnaire by phone, 45 could be examined clinically and radiologically. 23 patients had undergone a revision surgery for various reasons. The duration of follow-up varied between 8 and 12 years. The clinical assessment was based on the HSS score. Results were good to excellent in 80%, moderate in 7.5%, and poor in 12.5%. Patients with a poor result were scrutinized paying special attention to the surgical indication. Main reasons for poor results were rheumatoid arthritis, advanced osteoarthritis, loosening and subsidence of the tibial component. The survival rate after more than 10 years of 84 patients at risk, with the need of revision as endpoint, was 83.7%.
Operative Orthopädie und Traumatologie 01/2001; 13(3):221-232. · 0.46 Impact Factor
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ABSTRACT: Objective Correction of axial malalignment and restoration of a normal pain-free joint function through insertion of a unicompartmental runner. Indications Medial or lateral unicompartmental osteoarthritis. Osteonecrosis of the medial femoral condyle. Age over 60 years. Contraindications Osteoarthritis of more than one compartment. Ligamentous instability (instability due to cartilage loss is not a contraindication). Rheumatoid arthritis. Chronic synovitis. Systemic affections of joints (i.e., hemophilia). Neuropathic joint diseases. Obesity. Axial malalignment exceeding 20. Flexion contracture exceeding 20. Surgical Technique Medial approach. After visual confirmation that only one compartment is affected, resection of the tibial plateau while preserving cruciate and collateral ligaments. Preparation of the femoral condyle and restoration of axial alignment through insertion of the unicompartmental components. Avoid overcorrection. Results Between 1986 and 1990 a unicompartmental arthroplasty was done in 34 men and 115 women (62-86 years). 44 had died for unrelated reasons. 35 answered a questionnaire by phone, 45 could be examined clinically and radiologically. 23 patients had undergone a revision surgery for various reasons. The duration of follow-up varied between 8 and 12 years. The clinical assessment was based on the HSS score. Results were good to excellent in 80%, moderate in 7.5%, and poor in 12.5%. Patients with a poor result were scrutinized paying special attention to the surgical indication. Main reasons for poor results were rheumatoid arthritis, advanced osteoarthritis, loosening and subsidence of the tibial component. The survival rate after more than 10 years of 84 patients at risk, with the need of revision as endpoint, was 83.7%.
Orthopaedics and Traumatology 01/2001; 9(3):207-217.
