Le protesi composite in chirurgia ortopedica

A allograft-prosthetic composite is a method used for reconstruction of great loss of metaepiphyseal bone substance in prosthetic revisions, in posttraumatic loss of substance, and in oncologic orthopedic surgery. Composite technique is a combination of a massive allograft with a conventional joint prosthesis. The bone graft allows both the restoration of an appropriate metaphyseal bone stock, and a valid reinsertion of the tendon structures of the host. The prosthetic component warrants a rapid functional recovery, with a joint surface which is stable in time. The authors describe the surgical technique of prosthetic composites at the level of the proximal femur and the proximal tibia. Both anatomical locations have shown a greater functional advantage with this method than with the use of megaprosthesis after resection. The possibility of obtaining any valid insertion of the tendon of the gluteus muscles at the level of the hip allows the restoration of active abduction; at the proximal tibia, the anchorage of the patellar tendon warrants active knee extension. In extra-articular resections of the knee in oncologic surgery, prosthetic composite is a method of choice because it prevents the arthrodesis of the knee, and allows a functional reconstruction of the joint through the implant of a massive graft of the proximal tibia comprehensive of the extensor apparatus associated to a conventional long-stem prosthesis.