Total Femoral Replacement in Periprosthetic Femur Fracture: A Case Report

Total femur replacement (TFR) is one of the most extensive endoprosthetic reconstruction procedures. The most common indication for the use of total femoral replacement is limb salvage in malignant bone tumors of the femur. This procedure is rarely performed outside the paradigm of oncological limb reconstruction. With the increased incidence of total hip and total knee replacements, complications of these procedures are also on the rise. Cases of complicated revision arthroplasties with severe bone loss, infection, and comminuted periprosthetic fractures may not have adequate residual bone stock for satisfactory fixation of megaprosthesis. With limited reconstruction options, most of these cases are offered lower limb amputation. TFR can be used as a limb salvage option in place of amputation in such cases. There have been a few case reports of TFR for non-oncological indications in the literature. We present a case of periprosthetic comminuted distal femur fracture with a loose megaprosthesis following a road traffic accident (RTA), which was managed with TFR. At four years of follow-up, the patient showed good radiological as well as clinical outcomes.