Revision Total Hip and Total Knee Arthroplasty for Massive Bone Loss and Periprosthetic Fracture Using a Total Femur Prosthesis: A Case Report

Michel Taylor Gavin Wood

doi:10.4172/2161-0533.1000179

Abstract

The number of complex total joint arthroplasties being performed each year is continually rising. Patients are undergoing primary and revision total joint arthroplasties at a relatively younger age and face a greater possibility of multiple revision procedures during their lifetime. Surgeons are often faced with significant osteolysis and bone loss and must find ways novel ways to deal with this difficult problem. Total femur arthroplasty using a megaprosthesis is a rare procedure and has been mainly described in the orthopaedic oncological literature, however it has not been described in aseptic, non-tumour related, revision procedures addressing massive bone loss, component loosening and periprosthetic fracture involving ipsilateral hip and knee joints. We present the case of a simultaneous revision total hip and total knee arthroplasty for massive femoral bone loss, aseptic loosening, periprosthetic fracture and functional leg length discrepancy using total femur megaprosthesis. We will briefly review the relevant literature, present the clinical presentation, imaging and surgical procedure as well as the early post-operative course. To our knowledge, total femur replacement for this indication has not been previously described.

Highlights

Extensive bone loss and osteolysis is a common problem faced by arthroplasty surgeons [1,2,3]
In certain circumstances, the bone loss can be so extensive that none of these methods would allow for proper implant fixation, restoration of alignment or leg length
The first report describing TFR using a prosthesis was in 1965 [7] and since case series have been published predominantly in the surgical oncology literature [8,9,10] and smaller series of TFR performed for limb salvage after infection and periprosthetic fracture [11,12,13]

Summary

Introduction

Extensive bone loss and osteolysis is a common problem faced by arthroplasty surgeons [1,2,3]. We describe the case of a 56 year old woman who presented with several months of severe groin, leg and knee pain and an inability to bear weight and transfer secondary to left femoral bone loss, THA and TKR periprosthetic fractures and severe functional leg length discrepancy. Patient MG is a 59 year old woman with multiple medical comorbidities which include psoriatic arthritis, recurrent deep vein thrombosis, asthma, previous left total knee (1998) and hip (2006) replacements She presented to Kingston General Hospital, a tertiary care center in Kingston, Ontario with a suspected left hip fracture and bilateral pneumonias. Anteroposterior and lateral radiographs as well as computer tomography scan of her left hip, femur and knee leg were performed and showed massive femoral bone loss, loosening of the femoral component and periprosthetic fracture of the knee (Figures 4-6). The patient is clinically well and ambulating with the help of a walker

Discussion

NIH consensus conference