Megaprosthetic Total Knee Arthroplasty for Supracondylar Refracture in a Post-traumatic Osteoarthritic Knee: A Case...

Supracondylar femoral refracture in the setting of post-traumatic osteoarthritis presents a complex reconstructive challenge, particularly when prior fracture healing is incomplete and knee function is severely compromised. In such cases, conventional fixation or standard total knee arthroplasty may be associated with a high risk of failure and poor functional recovery.

A 77-year-old man with a remote history of distal femoral fracture, including a Hoffa fracture, presented with chronic pain, severe stiffness, and marked functional limitation. Following a fall, he sustained a supracondylar refracture. Radiographs and pre-operative computed tomography demonstrated advanced post-traumatic osteoarthritis, partial non-union, dense sclerosis, loss of normal cancellous architecture, and chronic distal femoral deformity. Despite apparently preserved bone stock on plain radiographs, these findings suggested poor biological healing potential. Intraoperatively, minimal bleeding from the distal femoral bone further supported severe biological compromise. Given the high risk of failed union with further internal fixation, persistent non-union, and poor functional recovery, one-stage distal femoral replacement using a megaprosthesis was performed. The patient achieved uneventful recovery with improved pain, range of motion, and ambulation.

Megaprosthetic reconstruction represents a rational salvage option for supracondylar femoral refracture in biologically compromised post-traumatic knees. Surgical decision-making should prioritize biological viability and realistic functional restoration rather than radiographic bone appearance alone.