A case of personalized limb salvage of the distal femur by three-stage distal femoral replacement

Abstract

Major distal femur defects involving the knee with underlying osteomyelitis and joint destruction require a staged surgical plan. We describe a case of a 21-year-old patient who suffered high-energy open diaphyseal and articular trauma of his right distal femur. Following radical debridement of bone and soft tissues, we implanted a cement spacer covered by a musculocutaneous flap. Previous tissue scarring did not permit knee function; therefore, we used a 250 ml soft tissue expander to create extra skin cover and we shortened the leg. A custom-made lengthening distal femoral replacement prosthesis was implanted, and the length was gained gradually followed by an intensive full range of motion exercises (0–125). We introduce the combination of first shortening and then lengthening a limb combined with the use of tissue expanders to create a soft tissue functional envelop for a knee prosthesis to work.

Keywords

• lengthening prosthesis
• limb salvage
• tissue expander