Tibia-hindfoot osteomusculocutaneous rotationplasty with calcaneopelvic arthrodesis for extensive loss of bone from the proximal part of the femur. A report of two cases.
We report a new technique to create an effective lower extremity weight-bearing stump for two patients who had extensive segmental loss of femoral bone proximal to the distal femoral condyles. One patient had previously had complete resection of the proximal part of the femur because of an infection following the insertion of a custom femoral replacement and hip arthroplasty prosthesis. The other patient had had débridement of the femur from the subcapital line to the femoral condyles because of post-traumatic osteomyelitis after failure of a reconstruction with a massive allograft. Both patients were managed with a tibia-hindfoot osteomusculocutaneous rotationplasty after transtarsal (Chopart) amputation, with calcaneopelvic arthrodesis to create stable fixation of the extremity to the pelvis; this fixation allowed flexion, extension, abduction, and adduction of the hip by means of the retained tibiotalar and subtalar joints. At the time of the latest follow-up (at thirty-three and forty-four months), both patients were bearing full weight, without pain, with the use of a standard above-the-knee-amputation prosthesis. We report this procedure as a useful alternative to disarticulation at the level of the hip in patients who have massive loss of femoral bone and destruction of the hip joint in association with scarred and previously infected soft tissues and are not considered to be candidates for other forms of limb-preservation reconstruction. The patient must be willing to accept the equivalent of a low above-the-knee amputation and recognize the potential value of a weight-bearing stump.
Peterson
C A
CA
Department of Orthopedics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Koch
L D
LD
Wood
M B
MB
D000328:Adult; D000672:Amputation Stumps / Q000601:surgery*; D001186:Artificial Limbs; D005260:Female; D005264:Femoral Fractures / Q000601:surgery; D005266:Femoral Neoplasms / Q000601:surgery; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000601:surgery; D013524:Surgical Flaps; D013997:Time Factors; D016474:Weight-Bearing