TIBIA-HINDFOOT OSTEOMUSCULOCUTANEOUS ROTATIONPLASTY WITH CALCANEOPELVIC ARTHRODESIS FOR EXTENSIVE LOSS OF BONE FROM THE PROXIMAL PART OF THE FEMUR - A REPORT OF 2 CASES

We report a new technique to create an effective lower extremity weigh t-bearing stump for two patients who had extensive segmental loss of f emoral bone proximal to the distal femoral condyles. One patient had p reviously had complete resection of the proximal part of the femur bec ause of an infection following the insertion of a custom femoral repla cement and hip arthroplasty prosthesis, The other patient had had debr idement of the femur from the subcapital line to the femoral condyles because of post-traumatic osteomyelitis after failure of a reconstruct ion with a massive allograft. Both patients were managed with a tibia- hindfoot osteomusculocutaneous rotationplasty after transtarsal (Chopa rt) amputation, with calcaneopelvic arthrodesis to create stable fixat ion of the extremity to the pelvis; this fixation allowed flexion, ext ension, abduction, and adduction of the hip by means of the retained t ibiotalar and subtalar joints, At the time of the latest follow-up (at thirty-three and forty-four months), both patients were bearing full weight, without pain, with the use of a standard above-the-knee-amputa tion prosthesis. We report this procedure as a useful alternative to d isarticulation at the level of the hip in patients who have massive lo ss of femoral bone and destruction of the hip joint in association wit h scarred and previously infected soft tissues and are not considered to be candidates for other forms of limb-preservation reconstruction T he patient must be willing to accept the equivalent of a low above-the -knee amputation and recognize the potential value of a weight-bearing stump.