SpringerLink
Log in

Aseptische Lockerung einer OSG‑Endoprothese und Konversion zur OSG‑Arthrodese

Aseptic loosening of total ankle replacement and conversion to ankle arthrodesis

  • Operative Techniken
  • Published:
Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Explantation einer aseptisch gelockerten Endoprothese am oberen Sprunggelenk (OSG), Augmentation der bestehenden knöchernen Defekte und achskorrekte, definitive OSG-Versteifung zur Schmerzlinderung eines periprothetischen Lockerungsprozesses und für eine belastbare untere Extremität.

Indikationen

Symptomatische, aseptische Lockerung einer OSG-Endoprothese mit/ohne signifikante ossäre Defekte des tibialen und/oder talaren Knochenlagers.

Kontraindikationen

Allgemeine chirurgische oder anästhesiologische Kontraindikationen, implantatassoziierte, lokale oder systemische Infektionen, chirurgisch/interventionell nicht beherrschbare Weichteilproblematiken.

Operationstechnik

Explantation der einliegenden Prothesenkomponente über bestehenden Zugang. Sorgfältiges Débridement des Knochenlagers auf tibialer und talarer Seite. Knöcherne Augmentation der Defekte mit autologer/homologer Spongiosa, ggf. Verwendung von strukturellen Allografts. Arthrodese in Doppelplattentechnik.

Nachbehandlung

Postoperativ Anlage eines wattegepolsterten Verbands. Medikamentöse Thromboembolieprophylaxe. Mobilisation ab dem 1. postoperativen Tag mit 15-kg-Teilbelastung in stabiler Orthese oder Unterschenkelgips für 6–8 Wochen. Bei regelrechtem postoperativem Verlauf und gesicherter fortschreitender ossärer Konsolidierung schrittweise Vollbelastung 6–8 Wochen postoperativ nach klinischer und radiologischer Verlaufskontrolle.

Ergebnisse

Revision der OSG-Prothese mit Konversion zur OSG-Arthrodese bei 9 Patienten (6 Männer, 3 Frauen, mittleres Alter 56,4 ± 7,0 Jahre; Spanne 47,8–66,0 Jahre) zwischen Januar 2007 und Dezember 2012. Zwischen ursprünglicher endoprothetischer Versorgung und Revisionseingriff lagen im Mittel 4,5 ± 2,4 Jahre (Spanne 1,2–7,9 Jahre). Postoperativ oberflächliche Wundinfektion bei einem Patienten sowie ein Fall einer verzögerten ossären Konsolidierung der Arthrodese nach 11 Monaten.

Abstract

Objective

To remove loosened prosthesis components, to perform augmentation, to address osseous defects, to perform neutrally aligned ankle arthrodesis, and to achieve postoperative pain relief.

Indications

Symptomatic, aseptic loosening of total ankle replacement (TAR) with/without substantial bone defect of the tibial and/or talar bone stock.

Contraindications

General surgical or anesthesiological risks, periprosthetic infection, local or systemic infection, nonmanageable soft tissue problems.

Surgical technique

Removal of both prosthesis components using the previous incision (mostly using anterior ankle approach). Careful debridement of bone stock at the tibial and talar side. Osseous augmentation of defects using autologous or homologous cancellous bone, if needed, using structural allografts.

Postoperative management

A soft wound dressing is used. Thromboprophylaxis is recommended. Patient mobilization starts on postoperative day 1 with 15 kg partial weight bearing using a stabilizing walking boot or cast for 6–8 weeks. Following clinical and radiographic follow-up at 6 weeks, full weight bearing is initiated gradually after progressive osseous healing has been confirmed.

Results

Between January 2007 and December 2012, ankle arthrodesis was performed in 9 patients with failed TAR (6 men and 3 women, mean age 56.4 ± 7.0 years, range 47.8–66.0 years). The mean time between the initial TAR and revision surgery was 4.5 ± 2.4 years (range 1.2–7.9 years). In one patient irrigation and debridement was performed due to superficial wound infection. Another patient had a delayed osseous healing 11 months after the revision surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2a,b
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7a–c
Abb. 8
Abb. 9

Literatur

  1. Alrashidi Y, Galhoum AE, Wiewiorski M, Herrera-Perez M, Hsu RY, Barg A et al (2017) How do I diagnose and treat infection in total ankle arthroplasty. Foot Ankle Clin 22: (akzeptiert für Publikation)

  2. Anderson T, Rydholm U, Besjakov J, Montgomery F, Carlsson A (2005) Tibiotalocalcaneal fusion using retrograde intramedullary nails as a salvage procedure for failed total ankle prostheses in rheumatoid arthritis. A report on sixteen cases. Foot Ankle Surg 11:143–147

    Article  Google Scholar 

  3. Austin MS, Ghanem E, Joshi A, Lindsay A, Parvizi J (2008) A simple, cost-effective screening protocol to rule out periprosthetic infection. J Arthroplasty 23:65–68

    Article  PubMed  Google Scholar 

  4. Barg A (2015) Natives Röntgen vom Rückfuß und Saltzman-Aufnahme. Fuss Sprunggelenk 13:58–77

    Article  Google Scholar 

  5. Barg A, Knupp M, Henninger HB, Zwicky L, Hintermann B (2012) Total ankle replacement using HINTEGRA, an unconstrained, three-component system: surgical technique and pitfalls. Foot Ankle Clin 17:607–635

    Article  PubMed  Google Scholar 

  6. Berbari E, Mabry T, Tsaras G, Spangehl M, Erwin PJ, Murad MH et al (2010) Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am 92:2102–2109

    Article  PubMed  Google Scholar 

  7. Berkowitz MJ, Clare MP, Walling AK, Sanders R (2011) Salvage of failed total ankle arthroplasty with fusion using structural allograft and internal fixation. Foot Ankle Int 32:493–502

    Article  PubMed  Google Scholar 

  8. Bullens P, de Waal Malefijt M, Louwerens JW (2010) Conversion of failed ankle arthroplasty to an arthrodesis. Technique using an arthrodesis nail and a cage filled with morsellized bone graft. Foot Ankle Surg 16:101–104

    Article  PubMed  Google Scholar 

  9. Carlsson A (2008) Unsuccessful use of a titanium mesh cage in ankle arthrodesis: a report on three cases operated on due to a failed ankle replacement. J Foot Ankle Surg 47:337–342

    Article  PubMed  Google Scholar 

  10. Carlsson AS, Montgomery F, Besjakov J (1998) Arthrodesis of the ankle secondary to replacement. Foot Ankle Int 19:240–245

    Article  CAS  PubMed  Google Scholar 

  11. Culpan P, Le Strat V, Piriou P, Judet T (2007) Arthrodesis after failed total ankle replacement. J Bone Joint Surg Br 89:1178–1183

    Article  CAS  PubMed  Google Scholar 

  12. Diaz-Ledezma C, Lamberton C, Lichstein P, Parvizi J (2015) Diagnosis of periprosthetic joint infection: the role of nuclear medicine may be overestimated. J Arthroplasty 30:1044–1049

    Article  PubMed  Google Scholar 

  13. Doets HC, Zurcher AW (2010) Salvage arthrodesis for failed total ankle arthroplasty. Acta Orthop 81:142–147

    Article  PubMed  PubMed Central  Google Scholar 

  14. Groth HE, Fitch HF (1987) Salvage procedures for complications of total ankle arthroplasty. Clin Orthop Relat Res 224:244–250. doi:10.1097/00003086-198711000-00033

  15. Hanna RS, Haddad SL, Lazarus ML (2007) Evaluation of periprosthetic lucency after total ankle arthroplasty: helical CT versus conventional radiography. Foot Ankle Int 28:921–926

    Article  PubMed  Google Scholar 

  16. Hintermann B, Barg A, Knupp M (2011) Revisionsarthroplastik des oberen Sprunggelenks. Orthopäde 40:1000–1007

    Article  CAS  PubMed  Google Scholar 

  17. Hintermann B, Zwicky L, Knupp M, Henninger HB, Barg A (2013) HINTEGRA revision arthroplasty for failed total ankle prostheses. J Bone Joint Surg Am 95:1166–1174

    Article  PubMed  Google Scholar 

  18. Hopgood P, Kumar R, Wood PL (2006) Ankle arthrodesis for failed total ankle replacement. J Bone Joint Surg Br 88:1032–1038

    Article  CAS  PubMed  Google Scholar 

  19. Horisberger M, Henninger HB, Valderrabano V, Barg A (2015) Bone augmentation for revision total ankle arthroplasty with large bone defects. Acta Orthop 86:412–414

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hsu AR, Haddad SL, Myerson MS (2015) Evaluation and management of the painful total ankle arthroplasty. J Am Acad Orthop Surg 23:272–282

    Article  PubMed  Google Scholar 

  21. Jehan S, Hill SO (2012) Operative technique of two parallel compression screws and autologous bone graft for ankle arthrodesis after failed total ankle replacement. Foot Ankle Int 33:767–771

    Article  PubMed  Google Scholar 

  22. Kamrad I, Henricson A, Magnusson H, Carlsson A, Rosengren BE (2016) Outcome after salvage arthrodesis for failed total ankle replacement. Foot Ankle Int 37:255–261

    Article  PubMed  Google Scholar 

  23. Kessler B, Knupp M, Graber P, Zwicky L, Hintermann B, Zimmerli W et al (2014) The treatment and outcome of peri-prosthetic infection of the ankle: a single cohort-centre experience of 34 cases. Bone Joint J 96:772–777

    Article  CAS  PubMed  Google Scholar 

  24. Kotnis R, Pasapula C, Anwar F, Cooke PH, Sharp RJ (2006) The management of failed ankle replacement. J Bone Joint Surg Br 88:1039–1047

    Article  CAS  PubMed  Google Scholar 

  25. Krenn V, Morawietz L, Perino G, Kienapfel H, Ascherl R, Hassenpflug GJ et al (2014) Revised histopathological consensus classification of joint implant related pathology. Pathol Res Pract 210:779–786

    Article  CAS  PubMed  Google Scholar 

  26. Mason LW, Wyatt J, Butcher C, Wieshmann H, Molloy AP (2015) Single-photon-emission computed tomography in painful total ankle replacements. Foot Ankle Int 36:635–640

    Article  PubMed  Google Scholar 

  27. McCoy TH, Goldman V, Fragomen AT, Rozbruch SR (2012) Circular external fixator-assisted ankle arthrodesis following failed total ankle arthroplasty. Foot Ankle Int 33:947–955

    Article  PubMed  Google Scholar 

  28. Middleton S, Toms A (2016) Allergy in total knee arthroplasty: a review of the facts. Bone Joint J 98-b:437–441

    Article  CAS  PubMed  Google Scholar 

  29. Morawietz L, Krenn V (2014) Das Spektrum histopathologischer Veränderungen in endoprothetisch versorgten Gelenken. Pathologe 35:218–224

    Article  PubMed  Google Scholar 

  30. Parvizi J, Della Valle CJ (2010) AAOS Clinical Practice Guideline: diagnosis and treatment of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg 18:771–772

    Article  PubMed  Google Scholar 

  31. Rahm S, Klammer G, Benninger E, Gerber F, Farshad M, Espinosa N (2015) Inferior results of salvage arthrodesis after failed ankle replacement compared to primary arthrodesis. Foot Ankle Int 36:349–359

    Article  PubMed  Google Scholar 

  32. Renz N, Müller M, Perka C, Trampuz A (2016) Implantatassoziierte Infektion – Diagnostik. Chirurg 87:813–821

    Article  CAS  PubMed  Google Scholar 

  33. Saltzman CL, el-Khoury GY (1995) The hindfoot alignment view. Foot Ankle Int 16:572–576

    Article  CAS  PubMed  Google Scholar 

  34. Schill S (2007) Interpositionsarthrodese des Sprunggelenks als Rückzug nach fehlgeschlagener Endoprothese. Oper Orthop Traumatol 19:547–560

    Article  PubMed  Google Scholar 

  35. Springer BD (2015) The diagnosis of periprosthetic joint infection. J Arthroplasty 30:908–911

    Article  PubMed  Google Scholar 

  36. Stauffer RN (1982) Salvage of painful total ankle arthroplasty. Clin Orthop Relat Res 170:184–188. doi:10.1097/00003086-198210000-00024

  37. Thomason K, Eyres KS (2008) A technique of fusion for failed total replacement of the ankle: tibio-allograft-calcaneal fusion with a locked retrograde intramedullary nail. J Bone Joint Surg Br 90:885–888

    Article  CAS  PubMed  Google Scholar 

  38. Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR et al (2007) Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 357:654–663

    Article  CAS  PubMed  Google Scholar 

  39. Williams JR, Wegner NJ, Sangeorzan BJ, Brage ME (2015) Intraoperative and perioperative complications during revision arthroplasty for salvage of a failed total ankle arthroplasty. Foot Ankle Int 36:135–142

    Article  PubMed  Google Scholar 

  40. Yue B, Tang T (2015) The use of nuclear imaging for the diagnosis of periprosthetic infection after knee and hip arthroplasties. Nucl Med Commun 36:305–311

    Article  PubMed  Google Scholar 

  41. Zwipp H, Grass R (2005) Arthrodesen des oberen Sprunggelenks nach Endoprothesenfehlschlägen. Oper Orthop Traumatol 17:518–533

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland

    M. D. Wimmer, M. Hettchen, M. M. Ploeger & D. C. Wirtz

  2. Klinik für Orthopädie und Traumatologie des Bewegungsapparates, Kantonsspital Baselland, Liestal, Schweiz

    B. Hintermann

  3. Harold K. Dunn Orthopädisches Forschungslabor, Orthopädische Klinik, Universität Utah, Salt Lake City, UT, USA

    A. Barg

  4. Orthopädische Klinik, Universität Utah, Salt Lake City, UT, USA

    A. Barg

Authors
  1. M. D. Wimmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Hettchen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. M. Ploeger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Hintermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. C. Wirtz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Barg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. D. Wimmer.

Ethics declarations

Interessenkonflikt

M. D. Wimmer, M. Hettchen, M.M. Plöger, D.C. Wirtz und A. Barg geben an, dass kein Interessenkonflikt besteht. B. Hintermann hat eine Beratertätigkeit bei Firma Integra Life Science.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

T. Mittlmeier, Rostock

Zeichner

R. Himmelhan, Mannheim

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wimmer, M.D., Hettchen, M., Ploeger, M.M. et al. Aseptische Lockerung einer OSG‑Endoprothese und Konversion zur OSG‑Arthrodese. Oper Orthop Traumatol 29, 207–219 (2017). https://doi.org/10.1007/s00064-017-0492-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00064-017-0492-x

Schlüsselwörter

Keywords

Search

Navigation