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Case Reports
. 2025 Apr 2;23(1):116.
doi: 10.1186/s12957-025-03759-5.

Successful limb-salvage procedure using a bioexpandable prosthesis after infected primary reconstruction of the distal femur in a skeletally immature patient: a case report

Jan Lesensky  1 , Ana C Belzarena  2 , Michal Benes  3
Affiliations
Case Reports

Successful limb-salvage procedure using a bioexpandable prosthesis after infected primary reconstruction of the distal femur in a skeletally immature patient: a case report

Jan Lesensky et al. World J Surg Oncol. .

Abstract

Background: Periprosthetic infections pose a devastating complication in skeletally immature patients treated for an orthopaedic oncological condition. Reconstructive approaches to revision procedures are often limited, and many cases still require amputation.

Case presentation: In this report, we present our unique experience with the bio-expandable MUTARS® BioXpand prosthesis, utilized during the second stage of a revision surgery in an adolescent female patient. Initially, the patient underwent reconstruction using a conventional endoprosthesis following the resection of a high-grade distal femur osteosarcoma; however, she developed a deep infection six months later. During a two-stage revision procedure, the infection was successfully eradicated at the cost of loss of growth potential at also the site of proximal tibia. The initial 5 cm limb-length discrepancy was restored through the application of bioexpandable endoprosthesis, which allowed for an 8 cm gain in bone stock. At the last follow-up appointment, the patient was fully weight-bearing and demonstrated excellent clinical outcomes, with no evidence of infection or tumor recurrence.

Conclusion: This successful limb-salvage procedure indicates that bioexpandable endoprosthesis may serve as a viable and effective reconstructive option in revision surgery for skeletally immature individuals.

Keywords: Bioexpandable prosthesis; Knee revision; Lengthening nail; Limb-salvage surgery; MUTARS® BioXpand; Periprosthetic infection; Precise nail.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This retrospective observational study of a human participant for a case report was reviewed and approved by Faculty and Hospital ethical committee. Consent for participation was waived given the retrospective nature of this study. Consent for publication: Consent was obtained for publication. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
X-ray (A) and magnetic resonance imaging (B) showing the tumor of the left distal femur. Resection was followed by reconstruction with growing endoprosthesis (C)
Fig. 2
Fig. 2
X-rays images showing the static cement spacer reinforced with a Küntscher nail in situ (A), and the Salter-Harris type V-like fracture of the proximal tibia with bone bridging (B)
Fig. 3
Fig. 3
The MUTARS® BioXpand distal femur prosthesis consisting of FITBONE® motorized nail (A), distal femur component (B), and tibial plateau component (C). Reprinted from Implantcast (n.d.)
Fig. 4
Fig. 4
Anteroposterior (A) x-ray images demonstrating the MUTARS® BioXpand implant in situ with bony fusion of the callus encountered during follow-up visit and status after re- osteotomy and elongation by 1 cm (B)
Fig. 5
Fig. 5
Anteroposterior (A) and lateral (B) x-ray images demonstrating the implanted definitive modular MUTARS® endoprosthesis
Fig. 6
Fig. 6
Final comparative images showing the levels of knee (A) and ankle (B) joints
See this image and copyright information in PMC

References

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