Revision Arthroplasty with Total Femur Replacement for the Management of Complex Post-traumatic Bone Defect in a Patient with Dwarfism

Abstract

Dwarfism leads to an early onset of osteoarthritis of the joints of the lower limb. Due to bone deformities, arthroplasty is challenging. The incidence of implant-associated complications is higher compared to the normal population and often ends up with multiple revision arthroplasties. We report the first case in the literature of a 48-year-old patient with dwarfism who required implantation of a custom-made total femoral replacement due to aseptic stem loosening and a concomitant valgus gonarthrosis.

Key words

dwarfism - total femur replacement - revision arthroplasty - bone deformity - custom made implant

• References/Literatur

• 1 Kopits SE. Orthopedic complications of dwarfism. Clin Orthop Relat Res 1976; (114) 153-179
• 2 Stanescu R, Stanescu V, Muriel MP. et al. Multiple epiphyseal dysplasia, Fairbank type: morphologic and biochemical study of cartilage. Am J Med Genet 1993; 45: 501-507 doi:10.1002/ajmg.1320450420
• 3 Guenther D, Kendoff D, Omar M. et al. Total Hip Arthroplasty in Patients with Skeletal Dysplasia. J Arthroplasty 2015; 30: 1574-1576 doi:10.1016/j.arth.2015.03.024
• 4 Peltonen JI, Hoikka V, Poussa M. et al. Cementless hip arthroplasty in diastrophic dysplasia. J Arthroplasty 1992; 7 (Suppl.) 369-376
• 5 Helenius I, Remes V, Tallroth K. et al. Total hip arthroplasty in diastrophic dysplasia. J Bone Joint Surg Am 2003; 85-A: :441-447
• 6 Modi RM, Kheir MM, Tan TL. et al. Survivorship and complications of total hip arthroplasty in patients with dwarfism. Hip Int 2017; 27: 460-464 doi:10.5301/hipint.5000484
• 7 Ahmed AR. Total femur replacement. Arch Orthop Trauma Surg 2010; 130: 171-176 doi:10.1007/s00402-009-0945-2
• 8 Hwang JS, Beebe KS, Patterson FR. et al. Infected total femoral replacements: evaluation of limb loss risk factors. Orthopedics 2011; 34: e736-e740 doi:10.3928/01477447-20110922-11
• 9 Friesecke C, Plutat J, Block A. Revision arthroplasty with use of a total femur prosthesis. J Bone Joint Surg Am 2005; 87: 2693-2701 doi:10.2106/JBJS.D.02770
• 10 Morimoto S, Futani H, Ogura H. et al. Successful reimplantation of total femoral prosthesis after deep infection. J Arthroplasty 2003; 18: 216-220 doi:10.1054/arth.2003.50037
• 11 de Sanctis J, Teixeira L, van Duin D. et al. Complex prosthetic joint infections due to carbapenemase-producing Klebsiella pneumoniae: a unique challenge in the era of untreatable infections. Int J Infect Dis 2014; 25: 73-78 doi:10.1016/j.ijid.2014.01.028
• 12 Steinbrink K, Engelbrecht E, Fenelon GC. The total femoral prosthesis. A preliminary report. J Bone Joint Surg Br 1982; 64: 305-312
• 13 Amanatullah DF, Trousdale RT, Hanssen AD. et al. Non-oncologic total femoral arthroplasty: retrospective review. J Arthroplasty 2014; 29: 2013-2015 doi:10.1016/j.arth.2014.05.012
• 14 Agrawal A, Agrawal V, Yadav S. et al. A Case Report of Dual Incision Technique for Total Femur Arthroplasty as a Salvage Procedure in Infected Non-Unions. J Orthop Case Rep 2017; 7: 44-47 doi:10.13107/jocr.2250-0685.844
• 15 Nerubay J, Katznelson A, Tichler T. et al. Total femoral replacement. Clin Orthop Relat Res 1988; (229) 143-148
• 16 Schindler OS, Cannon SR, Briggs TW. et al. Use of extendable total femoral replacements in children with malignant bone tumors. Clin Orthop Relat Res 1998; (357) 157-170 doi:10.1097/00003086-199812000-00021
• 17 Gehrke T, Zahar A, Kendoff D. One-stage exchange: it all began here. Bone Joint J 2013; 95-B: 77-83 doi:10.1302/0301-620X.95B11.32646