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01.11.2010 | Symposium: Highlights of the ISOLS/MSTS 2009 Meeting | Ausgabe 11/2010

Clinical Orthopaedics and Related Research® 11/2010

Revision of Broken Knee Megaprostheses: New Solution to Old Problems

Zeitschrift:
Clinical Orthopaedics and Related Research® > Ausgabe 11/2010
Autoren:
MS(Orth) Manish Agarwal, MS(Orth) Ashish Gulia, PhD B. Ravi, MS Rupesh Ghyar, MS(Orth) Ajay Puri
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s11999-010-1409-2) contains supplementary material, which is available to authorized users.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that all investigations were conducted in conformity with ethical principles of research.
This work was performed at Tata Memorial Centre.

Abstract

Background

Low-cost indigenous megaprostheses used in the developing world are prone to mechanical failure but the frequency and causes are not well established.

Questions/purposes

We retrospectively analyzed the causes of failure, particularly design, and suggest changes to reduce the breakage. We also report our experience with revision surgery.

Methods

We identified 28 breakages in 266 megaprosthetic knee arthroplasties performed between January2000 and December 2006. Twenty-six breakages were revised to another prosthesis. The complications were studied and the function was evaluated. Prostheses were studied for failure by the computer-aided design program SolidWorks® and Hyperworks® for finite element analysis (FEA). Design improvements were performed based on these results.

Results

In 21 cases, the failure occurred at the stem-collar junction, the point of maximum stress predicted by FEA. Stainless steel implants were prone to failure. There was one early and one late infection. Three patients died of metastatic disease. The most difficult surgical step involved the removal of the well-cemented broken stem from the intramedullary canal. Musculoskeletal Tumor Society scores varied from 27 to 29 after revision. FEA revealed stress could be reduced by filleting the stem-collar junction and by two-piece stems.

Conclusions

Revisions of broken total knee megaprostheses, though technically difficult, have allowed patients reasonable function. We recommend design analysis for custom prostheses to point to areas of weakness. Breakages can be reduced by using titanium stems and filleting the junction or by having two-piece inserted stems. Incorporating these changes has reduced the failures in our experience.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Zusatzmaterial
Supplementary material 1 (DOC 29 kb)
11999_2010_1409_MOESM1_ESM.doc
Supplementary material 2 (DOC 889 kb)
11999_2010_1409_MOESM2_ESM.doc
Literatur
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