Retrieval of Charité Disc Prosthesis. Experience in 15 Patients

Out of a series of 67 patients with persistent leg- and backpain after insertion of Charité disc prostheses we removed in 15 patients 18 prostheses and performed an anterior and posterior fusion. The indication for removal was our and the patients dissatisfaction after performing only posterior fusion in another series of 16 patients. The causes of persisting pain were subsidence, migration, wear, facetjoint degeneration and adjacent degeneration in various combinations. 10 patients were female, 5 male. Mean age at retrieval was 48 years (40-60 years) and time interval between insertion and retrieval was 9 years (range 3-16 years). Mean bloodloss for the anterior procedure was 541 cc (150-5100 cc). Intraoperatively we encountered 2 times a lesion of the vena iliaca communis and once a lesion of the arteria iliaca communis, that could be controlled by the vascular surgeon. In all patients polyethylene wear of the core was seen in various degrees with surrounding PE particles containing inflammatory fibrous tissue. The clinical results are diverse. Short segment fusions have a far better prognosis than long segment fusions or flexible fixations performed due to multilevel degeneration. This series shows, that removal of Charité artificial discs is feasible but with its inherent risks and that wear of the polyethylene core will be a major issue after moderate to long-term follow-up after Charité disc replacement surgery.