ALLOGENEIC VASCULARIZED GRAFTING OF HUMAN KNEE JOINTS UNDER POSTOPERATIVE IMMUNOSUPPRESSION OF THE RECIPIENT

Vascularized knee joint transplantations have been performed in variou s animal systems. Up to nom no allogeneic vascularized transplantation of a fresh and perfused human knee joint has been realized. This pape r reports on the First four grafted human knee joints, performed betwe en April 1996 and July 1997 at the Trauma Center Murnau. The indicatio n for transplantation of a human knee joint is total loss of the joint , including the extensor apparatus, following severe trauma. Managemen t of this defect is first to effect closure of the soft tissue defect combined with external transfixation and hone cement spacers. For the second phase the external stabilization is sc-itched to internal stabi lization using femoral and tibial nails and a temporary knee joint pro sthesis manufactured of polyethylene. The transplantations are perform ed viith respect to ABO compatibility ignoring the HLA system after a negative crossmatch. Osteosyratheses are employed by femoral and tibia l nails. The vascular anastomoses are established in an end-to-side te chnique between the recipient's superficial femoral vessels and the gr ab vascular pedicles. Immunosuppression starts as quadruple induction therapy for 3 days. Subsequently it is reduced to a two-drug maintenan ce protocol with cyclosporin A and azathioprine. We utilize radiograph y, digital subtraction angiography, duplex sonography, scintigraphy, a nd arthroscopy for grab monitoring. Six months after transplantation t he osteotomies were bridged with callus. and the patients were complet ely mobilized. The motion in the transplanted knee joint ranges from c omplete extension to 110 degrees flexion.