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

Faisal AlFayyadh; Anas Nooh; Michael Tanzer; Robert Turcotte; Adam Hart

doi:10.1016/j.artd.2023.101158

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

Arthroplast Today. 2023 Jul 12:22:101158. doi: 10.1016/j.artd.2023.101158. eCollection 2023 Aug.

Authors

Faisal AlFayyadh¹, Anas Nooh^{1

2}, Michael Tanzer¹, Robert Turcotte¹, Adam Hart¹

Affiliations

¹ Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada.
² Department of Orthopaedic Surgery, King Abdul-Aziz University, Jeddah, Saudi Arabia.

Abstract

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.

Keywords: Aseptic loosening; Cone; Custom implant; Distal femur replacement; Megaprosthesis.

Publication types

Case Reports