Total Femoral Replacement- A Case Report

Introduction: Total femoral replacement(TFR) is a well-recognized salvage procedure performed after multiple failed endoprosthetic replacements, which result in severely compromised bone stock and damaged structural integrity. TFR is performed as an alternative to lower limb amputation, restoring femoral integrity and enabling patients to resume ambulation. TFR is expected to be performed more frequently as the worldwide rate of revision arthroplasty increases due to improved patient survival rates and their underlying diseases, exceeding the functional life of endoprosthetic arthroplasty. We present a 74-year-old, overweight woman with an extensive surgical history with respect to her right knee. Her right lower extremity x-rays showed a long-cemented stem knee tumour prosthesis and a Garden 4 subcapital fracture of the ipsilateral hip. Due to multiple surgeries of the knee and femur in the past, a total femoral replacement was required to be performed. The procedure was successful, and the expected outcome was met. A successful procedure performed by a skilled and experienced surgical team, a thorough rehabilitation program, and prompt post-operative management of complications, can overcome the high incidence of infection and dislocation to preserve the limb with improved functionality and reduce pain. TFR is a drastic operative intervention that can preserve the quality of life for most patients.

Salvage of infected proximal tibial tumour prosthesis using vacuum assisted closure (VAC) in seven patients

<p class="abstract"><strong>Background:</strong> Proximal tibia is the second most common site for both benign and malignant bone tumours. The treatment protocols of such tumours have seen a paradigm shift from amputation towards limb salvage. Limb salvage has been possible with resection and reconstruction using custom modular prosthesis but the risk of tumour recurrence and infection still looms large<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Here we present our series of seven patients with infected proximal tibial tumour prosthesis which were salvaged using vacuum assisted closure (VAC) dressing. The indications for surgery were recurrent giant cell tumour (4 cases), chondrosarcoma (2 cases) and osteosarcoma (one patient). The prosthesis used was the limb preservation system (LPS) [Depuy-Synthes, US]. There were 6 males (M:F 6:1) with average age of 34.23 years. The predominant organism cultured was <em>Staph aureus</em>. We proceeded with radical wound debridement and VAC dressing with continuous negative pressure drainage for an average of 18 days (range 12-24 days). The patients then underwent secondary suturing and delayed suture removal (18-21 days).<strong></strong></p><p class="abstract"><strong>Results:</strong> All 7 patients were well at 8 months follow-up with no recurrent or persistent infection with good functional outcome. The average knee society score (KSS) was 73 (good)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> We conclude that with early thorough radical debridement and with select bacteriological culture profile, VAC is a valuable tool in the salvage of infected tumour prosthesis. This may reduce the need for amputations of such infected limbs by a significant margin while still retaining good functional outcome<span lang="EN-IN">.</span></p>

The Use of Structural Allograft in Primary and Revision Knee Arthroplasty with Bone Loss

Bone loss around the knee in the setting of total knee arthroplasty remains a difficult and challenging problem for orthopaedic surgeons. There are a number of options for dealing with smaller and contained bone loss; however, massive segmental bone loss has fewer options. Small, contained defects can be treated with cement, morselized autograft/allograft or metal augments. Segmental bone loss cannot be dealt with through simple addition of cement, morselized autograft/allograft, or metal augments. For younger or higher demand patients, the use of allograft is a good option as it provides a durable construct with high rates of union while restoring bone stock for future revisions. Older patients, or those who are low demand, may be better candidates for a tumour prosthesis, which provides immediate ability to weight bear and mobilize.