Successful limb-salvage procedure using a bioexpandable prosthesis after infected primary reconstruction of the distal femur in a skeletally immature patient: a case report.

Abstract

Background: Periprosthetic infections pose a devastating complication in skeletally immature patients treated for an orthopaedic oncological condition. Reconstructive approaches to revision procedures are often limited, and many cases still require amputation.

Case presentation: In this report, we present our unique experience with the bio-expandable MUTARS^® BioXpand prosthesis, utilized during the second stage of a revision surgery in an adolescent female patient. Initially, the patient underwent reconstruction using a conventional endoprosthesis following the resection of a high-grade distal femur osteosarcoma; however, she developed a deep infection six months later. During a two-stage revision procedure, the infection was successfully eradicated at the cost of loss of growth potential at also the site of proximal tibia. The initial 5 cm limb-length discrepancy was restored through the application of bioexpandable endoprosthesis, which allowed for an 8 cm gain in bone stock. At the last follow-up appointment, the patient was fully weight-bearing and demonstrated excellent clinical outcomes, with no evidence of infection or tumor recurrence.

Conclusion: This successful limb-salvage procedure indicates that bioexpandable endoprosthesis may serve as a viable and effective reconstructive option in revision surgery for skeletally immature individuals.