[Evaluation of 10 years experience with endo-exo femur prostheses - background, data and results]

Between 1999 and 2011 the Endo-Exo femur prosthesis has been applied to 54 patients. This comparatively new method for patient rehabilitation after upper leg amputation includes a two-step surgical procedure. The first step is an operation where the endomodule of the stem prosthesis is implanted in the bone via a press-fit technique. Then the soft tissue coat is closed to give the bone enough time for a secure osseointegration of the prosthesis. About six weeks later a stoma is cut out and the adapter for the exo-part is connected. The prosthesis is therefore intramedullary anchored and percutaneously penetrating the skin. A critical examination of this procedure has to put its main attention to the latent danger of an ascending, intramedullary infection. This may arise from the skin-penetrating stoma region at the distal stump. All data derived from patients operated in Lübeck, Germany have been evaluated focusing on reasons for objectionable operative procedures and their resulting terms of treatment. The evaluation shows that the initially high rate of stoma-associated infections of the soft tissue coat could be dramatically reduced through a change of design of the skin-penetrating parts. In between January 2009 and December 2011 (altogether 24 implants/23 patients) no operative revisions had to be undertaken because of infections of the stoma. Next to this there are more characteristics conditionally caused by the implant - like fractures of the affected extremity and other complications - presented in terms of cause-related case histories.