Custom Mega Prosthesis Knee: A Panacea for Intricate Trauma of Distal Femur with Bone Loss

Management of distal femoral intra-articular fracture with bone loss is an arduous endeavour. Although multiple reconstructive alternatives are available, the complexity of the fracture, amount of bone loss and the patient's expectations determine the treatment paradigm, before contemplating the pertinent treatment option for the patient.

We report the case of a 47-year-old male patient involved in a road traffic accident in which he sustained an open distal femoral intra-articular fracture with substantial loss of distal femoral shaft and the entire metaphyseal regions. Reconstruction options considered include osteochondral distal femoral allograft, ilizarov bone transport, free vascularised vascularized fibular graft with/without allograft, arthrodesis, and custom megaprosthesis of the distal femur. Considering all the merits and demerits of the aforementioned options and including patient's expectations in the treatment algorithm, custom megaprosthesis of the knee was designed and implanted. At 18 months follow-up, our patient showed gratifying results with a Musculo-skeletal Tumours Society MSTS score of 26, good articulation of the segments, no somatosensory or motor deficit, no infection, no dislocation, or periprosthetic fracture.

Using megaprosthesis to treat such intricate trauma provides better reconstruction with good restoration of limb length and torsion, improving the overall functionality of the limb and patient's psychological rehabilitation.