Revision Distal Femoral Replacement Using Custom-made Stem and Cone to Augment Proximal Fixation

Achieving bone fixation during megaprosthesis revision presents a formidable challenge in view of the substantial bone loss. We report treatment of a failed revision distal femoral replacement in an active 36-year-old male mechanic remotely treated for osteosarcoma. A custom stem and cone were manuf...

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Bibliographic Details
Published in:Arthroplasty today 2023-08, Vol.22, p.101158, Article 101158
Main Authors: AlFayyadh, Faisal, Nooh, Anas, Tanzer, Michael, Turcotte, Robert, Hart, Adam
Format: Article
Language:English
Subjects:
Aseptic loosening
Case Report
Cone
Custom implant
Distal femur replacement
Megaprosthesis
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Summary:Achieving bone fixation during megaprosthesis revision presents a formidable challenge in view of the substantial bone loss. We report treatment of a failed revision distal femoral replacement in an active 36-year-old male mechanic remotely treated for osteosarcoma. A custom stem and cone were manufactured to augment fixation and preserve bone stock within a short segment of the remaining proximal femur. The patient returned to regular function without the need for assistive devices. Follow-up imaging demonstrated stable implant fixation at 1-year follow-up. While cones and sleeves have vastly improved fixation in revision knee arthroplasty, a custom-made cone for the proximal femur was used to augment fixation of a revision megaprosthesis and obviate the use of a total femoral replacement.
ISSN:2352-3441
2352-3441
DOI:10.1016/j.artd.2023.101158