Case Study : Osteosarcoma revision of mega prosthesis after breaking
Background Information


Meena a lady of 42 years old had been suffering from tremendous pain and discomfort in her lower end femur. Diagnostics and tests proved that it was a case of Osteosarcoma. Her previous orthopedic had operated on her lower end femur and made a custom prosthesis constructed of Titanium. This prosthesis was fixed after a limb sparing surgery was conducted. However after a period of 4 years since the operation, Meena’s custom prosthesis failed due to metal fatigue at the junction after which she turned to Dr Sarin for help.

Bone X-RayTitanium CuttersCustom Built Prosthesis1Broken Bone

Challenges


Meena’s case was not a simple one by any stretch of the imagination. There were many challenges in her particular case some of which can be outlined as follows-

  • The custom implant took 3 weeks to make. Also the dimensions of the implant were not known making this task more challenging
  • If more bone is taken may shorten the limb
  • Bolt may not open at femoral and knee component because of cold welding
  • Impacted femoral stem with cement is the greatest challenge
  • Surgical incision was on medial side which had the risk of injuring nerve or vessels
  • Removal of cement from canal

Knee ComponentBody X-Ray
Solution


When designing the prosthesis, a Modular implant was preferred to avoid the risk of mismatch

Dr Sarin also decided to change knee component

For implementing this, titanium cutters and drilling instruments were arranged
Cement removal set were arranged
It was decided to take lateral approach


Procedure


A lateral incision was made on thigh and broken implant was just under the flap
There was lot of metallosis
Cental screw could be opened with no difficulty
Femoral component was broken at the junction of intamedulary rod due to metal fatigue
Distal end of femur was slightly shorted to hold the metallic rod could not be pushed from proximal or distal end as it was firmly fixed with cement.
Finally irtamedullary component was delivered by slitting the femur longitudinally

New modular implant was fixed which had longer intramedullry component


OsteosarcomaOsteosarcoma LegKnee ComponentsLeg Bone
Results


Patient could walk again comfortably after 2 weeks

 Leg After Surgery



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