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Review
. 2024 Mar;53(3):176-184.
doi: 10.1007/s00132-023-04453-8. Epub 2023 Oct 19.

[Tips and tricks of cement removal in the case of revision surgery]

[Article in German]
Marc-Pascal Meier  1 , Thelonius Hawellek  2 , Wolfgang Lehmann  2 , Gabriela von Lewinski  3
Affiliations
Review

[Tips and tricks of cement removal in the case of revision surgery]

[Article in German]
Marc-Pascal Meier et al. Orthopadie (Heidelb). 2024 Mar.

Abstract
in English, German

Background: In Germany, current revision rates after arthroplasty range between 28-37%. In particular, remaining cement residues are causative for additional revision surgery after periprosthetic joint infection, which is why complete cement removal is of high importance. However, the removal of remaining cement residues often confronts the surgeon with technical challenges. Complication-free and complete cement removal requires extensive preoperative preparation in order to develop the best possible surgical strategy.

Treatment: Special instrument sets to facilitate cement removal in revision cases are available from various manufacturers. In addition to endoluminal approaches, access enhancements such as extended osteotomies exist to facilitate complete cement removal. Finally, the surgeon should be able to give the indication for an intraoperative procedural change after a defined time interval.

Zusammenfassung: HINTERGRUND: Aktuelle Re-Revisionsraten nach endoprothetischem Gelenkersatz liegen in Deutschland bei 28–37 %. Insbesondere verbliebende Zementreste sind für erneute Revisionseingriffen nach Sanierungsoperationen bei periprothetischen Infektionen ursächlich, weswegen die vollständige Zemententfernung von großer Bedeutung ist. Die Entfernung letzter Zementreste stellt den Operateur jedoch häufig vor technische Herausforderungen. Eine komplikationslose und vollständige Zemententfernung bedarf einer umfangreichen präoperativen Vorbereitung, um die bestmögliche Operationsstrategie zu entwickeln.

Therapie: Von verschiedenen Herstellern werden Spezialinstrumente angeboten, die die Zemententfernung im Revisionsfall erleichtern. Neben endoluminalen Zugängen existieren Zugangserweiterungen wie zusätzliche Osteotomien, welche die vollständige Zemententfernung erleichtern. Nicht zuletzt sollte der Operateur in der Lage sein, nach einem definierten Zeitintervall die Indikation zum intraoperativen Vorgehenswechsel zu stellen.

Keywords: Arthroplasty; Bone cement; Surgical revision; Total hip replacement; Total knee replacement.

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References

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