Implantation of a Modular Distal Femoral Replacement with Compressive Osseointegration as a Salvage Procedure in a Complex Femoral Posttraumatic Setting

Abstract

Large bone defects and losses play a crucial role in both tumour surgery and in complex primary and revision total knee replacement. The established options of cemented or uncemented long intramedullary stems are limited by large bone defects and are at risk from relatively high exposure to aseptic loosening. There is no general valid agreement on implant fixation of the distal femur. A further option is the cementless fixation method with compressive osseointegration, based on the so-called Wolff law of bone remodelling. This method was developed in order to reduce the high loosening rates in revision arthroplasty due to intense stress shielding and is intended to be applied in patients with huge bone losses. The so-called Compress® system (or CPS) allows such a distal femur reconstruction. It has mainly been applied and evaluated in tumor endoprosthetics. There are currently few data on the application of this system in complex distal femoral posttraumatic deformity or revision arthroplasty. A case report of two male patients aged 59/56 years with a 1-year follow-up is presented. Both patients had a complex post-traumatic femoral deformity with bone loss, prior surgery and an ipsilateral hip replacement. Implantation was performed of a modular total knee replacement, consisting of a cemented modular tibia base plate and distal femoral replacement with cementless implant fixation by compressive osseointegration. Both patients were clinically and radiologically evaluated prospectively. Good clinical and radiological results were demonstrated in both patients after distal femoral replacement by compressive osseointegration. There was no need for further or revision surgery. Both patients were rapidly able to resume their jobs. The survival rates for CPS were comparable to published values with conventional procedures. There are yet no long-term results or extensive data for revision arthroplasty or posttraumatic cases. Besides distal femoral replacement with compressive osseointegration in oncological arthroplasty, the indication of complex distal femoral settings with large bone defects can be evaluated for daily clinical routine. Especially if there is ipsilateral total hip replacement, this option might be used to avoid interprosthetic stress risers.