Ugbeye Michael Ebiyon, Alatishe Kehinde Adesola, Lawal Wakeel Olaide
Arthroplasty Unit, Orthopaedic and Trauma Department, National Orthopaedic Hospital, Igbobi, Lagos, Nigeria.
Orthopaedic and Trauma Department, National Orthopaedic Hospital, Igbobi, Lagos, Nigeria.
J West Afr Coll Surg. 2025 Jan-Mar;15(1):83-86. doi: 10.4103/jwas.jwas_244_22. Epub 2024 Aug 2.
Total femoral replacement (TFR) is not a common surgery and most indications are for oncological pathologies. However, there are few instances where non-oncological indications might necessitate TFR; this may be a salvage surgery for failed previous hip and/or knee surgeries with consequent significant femur bone loss. We present a 59-year-old obese woman with right thigh pain and difficulty with walking of 5 years duration. She had undergone bilateral total knee replacement 10 years earlier on account of severe knee osteoarthritis. She had a fall 3 years prior to presentation and sustained a periprosthetic fracture around the right knee which was managed with a fixed angle blade plate and screws. This was complicated by implant breakage and non-union. She subsequently had implant removal and a right distal femur replacement (DFR) surgery 2 years prior to presentation. A year after the DFR surgery, she began to experience "start-up" pain, instability around the knee and difficulty with walking without support. A clinical and radiologic diagnosis of aseptic loosening of the distal femur megaprosthesis was made and she was offered a revision DFR surgery which also failed due to poor cementing technique, bone loss at the proximal femur, and severe osteoporosis. Patient ended up with a right total femur replacement to salvage the limb. She had improved Lower Extremity Functional Score of 27 after 12-month follow-up. TFR is a viable salvage procedure for severely compromised femur and/or significant bone loss from multiple non-oncological surgeries of the femur.
全股骨置换术（TFR）并非常见手术，多数适应证为肿瘤性病变。然而，在少数情况下，非肿瘤性适应证可能需要进行TFR；这可能是针对先前髋关节和/或膝关节手术失败并导致严重股骨骨质流失的挽救性手术。我们报告一名59岁肥胖女性，右大腿疼痛且行走困难达5年之久。她10年前因严重膝关节骨关节炎接受了双侧全膝关节置换术。就诊前3年她摔倒，右膝周围发生假体周围骨折，采用角钢板和螺钉固定治疗。这引发了植入物断裂和骨不连等并发症。随后，她在就诊前2年进行了植入物取出及右股骨远端置换术（DFR）。DFR手术后1年，她开始出现“启动”疼痛、膝关节不稳定以及无支撑行走困难。临床和影像学诊断为股骨远端大假体无菌性松动，她接受了DFR翻修手术，但由于骨水泥技术不佳、股骨近端骨质流失和严重骨质疏松，手术也失败了。患者最终接受了右全股骨置换术以挽救肢体。12个月随访后，她的下肢功能评分提高到了27分。对于因多次非肿瘤性股骨手术导致严重受损的股骨和/或大量骨质流失，TFR是一种可行的挽救性手术。
