Joint Preserving Periarticular Reconstruction of Proximal Femur After High-Grade Tumor Resection

Reconstruction after massive primary osseous tumor resection poses significant challenges given proximity to the physis, articular surface, adjacent joints, tendon insertions, and/or ligamentous attachments. The majority of patient undergo limb salvage surgery with endoprosthetic reconstructions, but some patients are eligible for joint preserving, limb-salvage reconstructions. With improvement of diagnostic imaging accuracy, joint preservation for optimizing long-term function and decreasing long-term surgically related events is the ideal goal. Bone regenerative procedures, such as distraction osteogenesis, when coupled with internal lengthening techniques offer promising options to achieve this goal safely and consistently despite the numerous obstacles. This case report presents the use of these techniques for a hip joint preserving proximal femur reconstruction of a 16 cm post-resection defect of a high-grade osteosarcoma of the femoral neck and metaphysis.