Operative Orthopadie Und Traumatologie最新文献

{"title":"[Treatment with TOPS for short femoral stump].","authors":"Marko Saß, Horst Heinrich Aschoff, Thomas Mittlmeier","doi":"10.1007/s00064-024-00885-3","DOIUrl":"10.1007/s00064-024-00885-3","url":null,"abstract":"<p><strong>Objective: </strong>Treatment with transcutaneous osseointegrated prosthesis systems (TOPS) for short femoral amputation stumps aims to restore independent walking ability after proximal femoral amputation by direct bone-guided prosthesis anchorage. This cannot be safely achieved with conventional socket prostheses due to the mechanically inadequate socket contact surface.</p><p><strong>Indications: </strong>Treatment of patients with short transfemoral stumps who cannot be mobilized sufficiently with conventional socket prostheses.</p><p><strong>Contraindications: </strong>Known contraindications as with standard TOPS fittings.</p><p><strong>Surgical technique: </strong>Special features already arise during positioning with correct orthograde adjustment of the short femoral stump under X‑ray fluoroscopy. The prosthesis is anchored using the specified technique, taking into account the central insertion of the femoral neck screw with the aid of the aiming arm under X‑ray fluoroscopy in two planes.</p><p><strong>Postoperative management: </strong>In most cases, step 1 and 2 treatment is primarily possible, i.e., insertion of the double-cone adapter and passing through the skin by the intraoperatively created stoma (skin opening on the amputation stump). This requires patient compliance and hygiene with twice daily showering of the stoma and dressing. After the exoprosthesis components have been fitted by the patient's orthopedic technician, weight-bearing with the new adapted prosthesis is possible.</p><p><strong>Results: </strong>A total of 14 TOPS procedures were performed at Rostock University Medical Center between 2022 and 2024, including 9 patients with short femoral stumps. A prolonged rehabilitation phase compared to patients with \"standard\" TOPS restorations is not recognizable, but a significant gain in quality of life is evident.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"114-123"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Reconstruction of the patellar tendon with autologous or allogeneic semitendinosus tendon transplant for chronic rupture].","authors":"Wolf Petersen, Hasan Al Mustafa, Martin Häner, Karl Braun","doi":"10.1007/s00064-024-00859-5","DOIUrl":"10.1007/s00064-024-00859-5","url":null,"abstract":"<p><strong>Objective: </strong>Reconstruction of a patellar tendon defect in the event of a chronic rupture.</p><p><strong>Indications: </strong>Chronic rupture of the patellar tendon due to delayed diagnosis or failure of primary refixation with a dehiscence that does not allow for anatomical refixation without patellar tendon shortening.</p><p><strong>Contraindications: </strong>Infection.</p><p><strong>Surgical technique: </strong>Approximately 15 cm long incision from the tibial tuberosity to the patella. Depicting the rupture. Debridement of the tendon and insertion. Suture in the quadriceps tendon and distalization of the patella. If sufficient distalization of the patella is not possible, optionally perform a VY-plasty of the quadriceps tendon. Measuring the dehiscence. Securing the height of the patella by applying a patellotibial cerclage (strong suture cord). Extension of an existing tendon stump using a Z-plasty. Creation of 2 bone tunnels (diameter approx. 5 mm) in the patella and the tibial tuberosity. Insertion of an autologous or allogeneic semitendinosus tendon transplant and securing it by knotting the retaining threads in front of the tibial tuberosity.</p><p><strong>Postoperative management: </strong>Six weeks of partial weight-bearing with 10 kg of body weight in a straight, removable splint. Range of movement: weeks 1-4 E/F 0-0-60°, weeks 5-6 E/F 0-0-90°.</p><p><strong>Results: </strong>Seven patients who underwent this surgery as described above had a minimum follow-up of 2 years. Secondary lengthening of the quadriceps tendon had to be performed twice due to excessive retraction. All patients were able to perform active extension postoperatively. The Lysholm score rose from 49.3 to 83.2 points. No further rupture was detectable in the final ultrasound examination.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"150-158"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Treatment of diametaphyseal forearm fractures in children and adolescents : Antegrade intramedullary nail osteosynthesis and its alternatives].","authors":"H Rüther, C Spering, L Fortini, K Dresing, W Lehmann, T Radebold","doi":"10.1007/s00064-024-00877-3","DOIUrl":"10.1007/s00064-024-00877-3","url":null,"abstract":"<p><strong>Objective: </strong>Osteosynthesis in dislocated diametaphyseal forearm fractures is intended to restore anatomy and function. Antegrade intramedullary nailing in the radius is used to restore length, rotation, and axis within the age-specific correction limits. Sufficient stability ensures early functional postoperative treatment without load.</p><p><strong>Indications: </strong>Dislocated diametaphyseal forearm or radius fractures that cannot be closed, stably reduced, or remain outside the age-specific correction limits.</p><p><strong>Contraindications: </strong>Radius or forearm fractures located distal or proximal to the defined area. Soft tissue defects, contamination or infections located in the access path.</p><p><strong>Surgical technique: </strong>In the course of the Thompson approach, the soft spot between the extensor digitorum and extensor carpi radialis brevis muscles is located and an approx. 3-4 cm skin incision is made. Then blunt preparation down to the bone, sparing the profundus and superficial radial nerve. Retraction of the musculature with two Langenbeck hooks. Opening of the cortex with an awl. If necessary, a 2.5 mm drill with tissue protection can be used beforehand if the cortex is very hard. A titanium elastic nail (TEN) diameter is selected so that it fills approximately 2/3 of the medullary canal. It is recommended to flatten the TEN runner with parallel flattening forceps. After closed reduction, the TEN is then brought up in front of the growth plate with slightly rotating movements. The TEN is bent over at the proximal end and pinched off above the muscle bellies. Alternative procedures include Kirschner wire osteosynthesis or retrograde TEN from radial or dorsal, with or without bending.</p><p><strong>Postoperative management: </strong>The aim of osteosynthesis is early functional follow-up without load. Sports abstinence is recommended for 8 weeks. Metal removal can be performed after consolidation between 3 and 6 months.</p><p><strong>Results: </strong>Clearly dislocated or outside the correction limits infantile radius and forearm fractures show very good treatment results with a low risk profile after the described osteosynthesis technique. Pseudarthrosis and nerve damage were not observed. Secondary dislocation has not occurred.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"159-170"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11958432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical technique of a bone-anchored prosthesis for transhumeral amputees.","authors":"Jan Paul Frölke, Horst Aschoff, Henk Van de Meent, Thomas Mittlmeier","doi":"10.1007/s00064-025-00894-w","DOIUrl":"10.1007/s00064-025-00894-w","url":null,"abstract":"<p><strong>Objective: </strong>Fixating an arm prosthesis with a transcutaneous bone anchor provides a more comfortable and stable attachment than conventional socket-attached prosthetics. The objective is that bone anchoring will improve prosthetic usage, reduce prosthesis rejection, and aid to functions in daily life activities.</p><p><strong>Indications: </strong>Subjects with transhumeral amputation or elbow disarticulation and insufficient functional effect of conventional socket-attached arm prostheses.</p><p><strong>Contraindications: </strong>Patients with local or systemic inflammatory processes, bone metabolism disorder, active use of chemotherapeutic or immunosuppressive medications and medically unexplained pain conditions in the respective residual arm.</p><p><strong>Surgical technique: </strong>A cylindrical BADAL next (OTN Implants Germany, Rostock, Germany) humerus implant is transcutaneously inserted using a retrograde press-fit approach. The distal taper of the implant is connected to an adapter that serves as an abutment for the fixation of the postoperative load-set and arm prosthesis.</p><p><strong>Postoperative management: </strong>Postoperative pain medication according to standard guidelines for shoulder surgery. Stoma care instructions before discharge from the hospital. Progressive loading at 6 weeks postoperatively using load plates of 100 g using in a compatible load set. Installation of an external arm prosthesis as soon as the weight of the arm prosthesis is reached.</p><p><strong>Results: </strong>In 4 individuals with median follow-up of 11 months, implant survival was 100%, prosthetic use improved from 0 h to an average 14 h per week, and no arm prosthesis rejection occurred. On a functional level, the 4 individuals improved from 0 to 5 on the patient-reported outcome measure (PROM) 33ADL PWP. This PROM measures 33 daily activities that can or can not be carried out with the prosthesis. No adverse events were reported.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"101-113"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Transcutaneous osseointegrated prosthetic system (TOPS) with an intramedullary prosthesis : Management of the femoral stump with concurrent total hip arthroplasty].","authors":"Thomas von Stein, Julia Rehme-Röhrl","doi":"10.1007/s00064-024-00874-6","DOIUrl":"10.1007/s00064-024-00874-6","url":null,"abstract":"<p><strong>Objective: </strong>Simultaneous implantation of a TOPS (transcutaneous osseointegrated prosthetic system) and THA (total hip arthroplasty) or staged approach.</p><p><strong>Indications: </strong>Patients with a TOPS who have coxarthrosis. Patients with an existing THA who have required above-knee amputation and need a TOPS. Patients with an existing TOPS who sustain a medial femoral neck fracture and are not stabilizable with osteosynthesis.</p><p><strong>Contraindications: </strong>Atypical anatomy, osteomyelitis, radiation or chemotherapy to the affected limb in the last 18 months, peripheral occlusive arterial disease with critical ischemia, diabetes mellitus with polyneuropathy, local dermal or systemic infection, immunocompromised state or use of immunosuppressants, cognitive impairment or lack of compliance for the system, other significant physical impairments.</p><p><strong>Surgical technique: </strong>Individualized preoperative planning based on CT data. Access similar to conventional THA for existing TOPS. Implantation of an artificial acetabulum with a matching inlay. Similar approach for medial femoral neck fractures without reconstructive options. For existing THA and prior above-knee amputation, removal of existing shaft and potentially neck component for modular prosthesis. Subsequent implantation of TOPS stem in conventional manner.</p><p><strong>Postoperative management: </strong>Additional THA requires appropriate rehabilitation following endoprosthesis guidelines, tailored to the TOPS situation. For simultaneous implantation of TOPS and THA the patients' load-bearing capacity and mobilization depend on the duration of the implanted stem.</p><p><strong>Results: </strong>Only 4 patients have been treated at BGU Murnau making statistical analysis not feasible. Three of the 4 patients experienced significant pain relief and improved mobility shortly after surgery. One patient remained as immobile postoperatively as preoperatively due to inability to achieve pain-free full weight-bearing.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"124-132"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Implantation of a stem- and cement-free inverted shoulder prosthesis].","authors":"H Wille, M Szakacs, J Zeichen","doi":"10.1007/s00064-025-00891-z","DOIUrl":"10.1007/s00064-025-00891-z","url":null,"abstract":"<p><strong>Objective: </strong>Safe and bone-sparing implantation of a stem- and cement-free reversed shoulder prosthesis.</p><p><strong>Indications: </strong>Shoulder arthritis with rotator cuff degeneration, symptomatic rotator cuff arthropathy with no further therapy, posttraumatic arthritis, rheumatoid arthritis, humeral head necrosis, revision surgery after implantation of a surface prosthesis.</p><p><strong>Contraindications: </strong>Infection, axillary nerve lesion, deltoid muscle insufficiency, insufficient central glenoid bone substance for glenoid screw fixation.</p><p><strong>Surgical technique: </strong>Implantation of the shoulder prosthesis via a standard deltopectoral approach. Dissection and resection of the humeral head. Glenoid preparation, soft tissue release, baseplate and glenosphere placement. Implantation of the humeral shell and inlay.</p><p><strong>Postoperative management: </strong>Short-term immobilization in a Gilchrist bandage. Followed by early functional rehabilitation.</p><p><strong>Results: </strong>The surgical technique has so far been used in 42 cases in the author's clinic. Both objectively and subjectively, good postoperative results and a significant reduction in pain were observed in the patients.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"171-180"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical technique of minor revision of a transcutaneous osseointegration prosthetic system (TOPS) with implant retention.","authors":"Jan Paul Frölke, Robin Atallah","doi":"10.1007/s00064-024-00882-6","DOIUrl":"10.1007/s00064-024-00882-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Transcutaneous osseointegration prosthetic systems (TOPS) offer a stable skeletal attachment for artificial limbs post-extremity amputation, serving as an alternative to socket attachment. Press-fit osseointegration implants (OI) utilized in TOPS consistently enhance quality of life and mobility for amputees, particularly those experiencing socket-related issues. Despite notable benefits, late complications such as infection and implant loosening pose challenges unique to TOPS due to their percutaneous nature. Recent studies indicate a low risk of implant failure but highlight the prevalence of minor soft tissue complications. Successful TOPS implementation is hypothesized to rely on early osseointegration and effective drainage of fluid discharge from the stoma. Factors influencing implant survival encompass implant characteristics, bone quality, and host factors. Longitudinal follow-up data reveal changes in periprosthetic bone and soft tissue conditions over time, necessitating ongoing clinical management. Distal bone resorption, evidenced by X‑ray, may result from stress shielding or local osteitis, leading to stoma-related complaints and jeopardizing implant survival. Understanding these dynamics is crucial for optimizing TOPS outcomes and addressing evolving patient needs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Indications: &lt;/strong&gt;Purulent and bloody discharge from the stoma with pain and radiographic evidence of distal cortical resorption.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Contraindications: &lt;/strong&gt;Complaints attributed to other pathologies, signs of progressive bone resorption or implant loosening.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Surgical technique: &lt;/strong&gt;We propose a unique innovative surgical approach to address symptomatic distal bone resorption in individuals undergoing treatment with press-fit transcutaneous osseointegration prosthetic systems (TOPS) following limb amputation. Distal bone resorption can lead to painful symptoms and compromise the effectiveness of TOPS, necessitating a stepwise intervention strategy. The protocol involves assessing cortical involvement through radiographs, followed by surgical debridement with assessment of potential implant loosening. The next step involves application of a two-part mirror-polished sleeve to mitigate local soft-tissue irritation and promote physiological drainage. Patient education is paramount, emphasizing the potential for limited pain relief and the risk of postoperative infectious complications. This protocol offers a structured approach to managing distal bone resorption in TOPS recipients, aiming to optimize treatment outcomes while ensuring informed patient consent.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Postoperative management: &lt;/strong&gt;Following surgery, the cement used to fixate the sleeve must harden and after 24 h the leg prosthesis can be clicked on again. With regard to the surgical wound, no special measures are necessary other than standard orthopedic postoperative wound care. In view of this revision surgical proce","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"133-141"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Transcutaneous osseointegrated prosthesis systems (TOPS)-specific indications and revision techniques].","authors":"Thomas Mittlmeier, Horst-H Aschoff","doi":"10.1007/s00064-025-00898-6","DOIUrl":"10.1007/s00064-025-00898-6","url":null,"abstract":"","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":"37 2","pages":"87-88"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical technique of a transcutaneous osseointegration prosthesis system (TOPS) for transtibial amputees.","authors":"Jan Paul Frölke, Ruud Leijendekkers, Robin Atallah","doi":"10.1007/s00064-025-00888-8","DOIUrl":"10.1007/s00064-025-00888-8","url":null,"abstract":"<p><p>Transcutaneous osseointegration prosthetic systems (TOPS) are intended to provide stable skeletal attachment for artificial limbs after extremity amputation and is an alternative for socket attachment. TOPS for individuals with limb amputation using osseointegration implants (OI) has proven to consistently and significantly improve quality of life and mobility for the vast majority of amputees, previously using a socket prosthesis also experiencing socket-related problems. As with any implant, complications such as infection, aseptic loosening, or implant fracture can occur, which may necessitate hardware removal. Approximately half of patients who undergo a below-knee amputation are able to utilize an artificial leg acceptably well with a socket-suspended prosthesis. However, the other half of patients experience limitations resulting in reduced prosthesis use, mobility, and quality of life. Limb-to-prosthesis energy transfer is poor because of the so-called \"pseudojoint\" (i.e., the soft tissue interface), and gross mechanical malalignment is common. Furthermore, transtibial amputees may experience irritation from pistoning and suction at the residual limb-socket interface. These issues result in skin problems and difficulties with socket fit because of fluctuation in the size of the residual limb size, resulting in a decrease in overall satisfaction and confidence in mobility. A bone-anchored implant creates a direct skeletal connection between the residual limb and artificial leg, in which energy transfer is optimal and mechanical alignment is significantly improved.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"89-100"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11958483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Transcutaneous osseointegrated prostheses systems (TOPS) for rehabilitation following limb loss : Surgical approach for necessary removal of the implant].","authors":"Horst-Heinrich Aschoff, Marko Sass, Thomas Mittlmeier","doi":"10.1007/s00064-024-00883-5","DOIUrl":"10.1007/s00064-024-00883-5","url":null,"abstract":"<p><strong>Objective: </strong>Removal of a transcutaneous osseintegrated endo-fix stem (ESKA Orthopaedic, Lübeck, Germany) following a fatigue fracture of the implant, whilst protecting the residual femur bone to allow transcutaneous osseointegrated prosthesis system (TOPS) reimplantation.</p><p><strong>Indications: </strong>A patient's request for a further TOPS implantation following a fatigue fracture of a circular osseointegrated implant stem.</p><p><strong>Contraindications: </strong>Impending destruction of the bone tube through mobilisation of the femoral implant stem with insufficient thickness of the cortical wall (< 2-3 mm). This fact has to be considered before providing the indication for implant replacement.</p><p><strong>Surgical technique: </strong>A fatigue fracture of a circular osseointegrated implant stem is generally associated with difficult removal of the implant. The longitudinal osteotomy of the tubular femur would lead to massive destruction of the bone due to the osseointegration of the corticalis into the three-dimensional structured surface of the implant and must be excluded as an option for removal. Therefore, the implant must be mobilized from the distal end of the bone. For this approach, tubular cutters and shock wave chisels are available. The procedure itself is time-consuming and is accompanied by a weakening of the corticalis of the femur bone. Intraoperative smear tests to prove a bacteria-free intramedullary space are obligatory.</p><p><strong>Postoperative management: </strong>After successful removal of an endo-fix stem, reassembling of a new TOPS implant should be considered 4-6 weeks later after ensuring the absence of bacterial colonization of the intramedullary space. If bacteria are detected, surgical revision is necessary.</p><p><strong>Results: </strong>The authors experience with the described removal of the implant with 4 patients over a period of 17 years must be regarded as anecdotal. All 4 patients could be successfully re-implanted, which emphasizes the value of the described method.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"142-149"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}