Distal Femur Prosthetic Revision Aided by Soft Tissue Distraction and Titanium Mesh Cage Defect Reconstruction Followed by Tibial Lengthening

The distal femur is one of the most common sites involved by primary malignant bone tumors in the skeletally immature population. Although bone tumors around the knee joint are successfully treated with prosthetic replacement, intraarticular resection with the growth plate leads to limb length discrepancy. In skeletally immature patients, a lifetime surgical plan involving lengthening sessions at selected age is essential for the reconstruction. In this case, we present the limb reconstruction after the distal femoral malignant bone tumor excision. Initially, the knee joint was replaced with a tumor replacement prosthesis. At skeletal maturity, femoral soft tissue distraction enabled reconstruction of the remaining defect with a titanium mesh cage filled with cement. Finally, tibial lengthening with a computer-assisted fixator was performed to equalize the remaining limb length.