Distraction Osteogenesis for Knee Arthrodesis in Infected Tumor Prostheses

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Abstract

Three patients had distraction osteogenesis as a salvage method for infected endoprostheses. At the first operation, the infected prosthesis was removed and stabilization was achieved with an external fixator to preserve limb length. An additional external fixator was applied later for distraction osteogenesis after ensuring that there was no infection. Osteotomy was done at two sites on the femur, or tibia and femur, respectively, as a second operation. A third surgery was done at the docking site at the edge of the transported bone fragments. Curettage, refreshing, and soft tissue release were done to enhance bone union. The healing index was 18.3 days/cm in Patient 1, 17.7 days/cm in Patient 2, and 33.0 days/cm in Patient 3. All patients walk without a cane. It has been shown that patients can obtain a long-lasting and weight-bearable leg with our method, because their viable bone establishes biomechanical stability. Loss of knee function, a longer treatment period, and pin site treatment are the weaknesses of our method. Our method is indicated for patients in whom systemic disease can be controlled well and who have longer life expectancy.

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