Case Study

Case Study

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Total Femur Replacement
While the conventional treatment of primary malignant bone tumors has been Amputation, Limb Salvage Surgery is now the standard of care for such tumors. It is now established that Limb salvage gives a far superior psychological and functional outcome, without compromising on the survival of the patient. The main factors responsible for the establishment of limb salvage as a standard modality of care are the advancements in Surgery, Imaging, Pathology, Prosthetics, Chemotherapy and Radiotherapy.

There are certain situations where the indications for Limb Salvage surgery are relative and we have to "walk that extra mile" to save the limb while providing adequate oncological clearance. Following is the report of one such patient, where the whole femur had to be replaced to save the limb.

Mrs BD, a middle aged female, presented to us with the complaint of pain in the left thigh for 1 year duration. She had a history of a fracture in the subtrochanteric region, being treated by intramedullary nailing about 5 years back. The surgeon had sent some curretted material for histopathological examination, the report of which turned out to be "Cartilaginous Tumor”. There was recurrence of the swelling and pain about 1 year back. The fresh X ray showed an interlocked nailing having been done, and the radiological diagnosis was obviously chondrosarcoma (Figure 1). The intramedullary nail spanned the whole femur upto the distal metaphysis. She was investigated with a CT scan of the thigh and the chest and a bone scan, which was found to be non metastatic. The main issue to be addressed here was that the whole of the bone was contaminated with tumor following previous intramedullary nailing. After a detailed discussion of the options, she was taken up for total femur resection and replacement with total femur modular megaprosthesis.

After isolation of the neurovascular structures, the whole femur with a cuff of normal tissue all around (enclosing the old surgical scar in the incision) was resected (Figure 2). The limb was reconstructed with a modular total femur replacement prosthesis with a modular bipolar cup (Figure 3, 4), followed by meticulous capsular and soft tissue repair (Figure 5). The patient recovered well and has been mobilized with a hip abduction brace.

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