Distal Femoral Resection with Endoprosthetic Reconstruction
The distal femur (Figure 30.1) is the most common site of osteosarcoma. Patients with osteosarcoma of the distal femur have traditionally been treated with a high above-knee amputation or hip disarticulation. Today, with arlier diagnosis and induction chemotherapy, approximately 95% of osteosarcomas can be resected with tumor-free margins. Careful preoperative evaluation and strict adherence to established criteria for resection of bone cancers are required to minimize the risk of local recurrences. Prosthetic reconstruction of the distal femur is an option that must be considered in all these patients. Use of the modular segmental replacement system (MRS) can provide limb salvage in many patients. The functional results are excellent, and patient satisfaction is high. The prosthesis has an excellent long-term survival rate, is reliable, and presents minimal problems of breakage or dysfunction.
This chapter describes in detail the preoperative staging, use of imaging studies, and the surgical technique of popliteal exploration, femoral resection, and prosthetic and soft-tissue reconstruction.
KeywordsDistal Femur Limb Salvage Medial Gastrocnemius Superficial Femoral Artery Fasciocutaneous Flap
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