Mesh application enhances osteoinduction following proximal femur chondrosarcoma resection and Total hip arthroplasty: A case report and novel technique.

Introduction and importance: Salvage arthroplasty with revision hip prosthesis following long osteotomies and extensive soft tissue dissection is a challenging aspect of reconstructive surgery in oncology patients. This study aims to report on enhanced and faster osteoinduction with the use of mesh around hydroxyapatite (HA)-coated femoral stem.

Case presentation: A 60-year-male presenting with features of proximal femur chondrosarcoma as seen on radiography and suspected on biopsy. He underwent wide-margin surgical resection and salvage uncemented total hip arthroplasty using modular endoprosthesis with autograft, allograft and bone substitute wrapped within a polypropylene mesh (morselized). Xray at 2 months postoperatively showed a faster and early evidence of new bone formation between the HA-coated femoral stem and bone graft within the mesh.

Clinical discussion: Proximal femur chondrosarcoma treated with wide-margin surgical resection including extensive osteotomy and soft tissue resection which poses biomechanical challenges including implant failure, joint instability, nonunion and bone resorption/osteolysis,. Salvage reconstruction using HA-coated modular revision endoprosthesis, morselized bone graft and covered by polypropylene mesh allows early osteoinduction and bone ingrowth. In vivo, in vitro and animal studies on polypropylene mesh show connective tissue ingrowth.

Conclusion: The application of polypropylene mesh around a HA-coated femoral stem resulted in an enhanced bone formation at the prosthesis/bone graft interface in vivo. Bone stock regeneration in salvage hip replacements is of paramount importance to improve stability, enhance implant longevity and patient's quality of life and postoperative outcomes.