PMC4094698_01
Radiographs of the left femur and knee at initial presentation. Anteroposterior (a) and lateral (b) views of the left femur 18 years after revision surgery show severe loosening of the acetabular cup and femoral stem. Radiographs of the left knee show the distal end of the stem had perforated the medial femoral condyle, reaching subcutaneous tissue through the knee joint (c), (d).
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fig1
The femorotibial joint showed a large osteochondral defect (3 cm in diameter) in the medial femoral condyle, as suggested by radiographic findings (Figure 1).
Computed tomography (CT) images of the left femur. Coronal CT image of the left femur shows a massive osteolytic lesion involving two-thirds of the proximal femur with thin cortical fragments surrounding the stem (a). Most of the cement mantle has disappeared except around the greater trochanter and middle of the stem. Axial views from the dotted lines are noted (b)-(d).
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Computed tomography revealed marked expansion of the proximal femoral medullary canal, which was surrounded by a thin eggshell-like cortex (Figures 2(a)-2(d)).
PMC4094698_02
Radiographs of the left femur and knee at initial presentation. Anteroposterior (a) and lateral (b) views of the left femur 18 years after revision surgery show severe loosening of the acetabular cup and femoral stem. Radiographs of the left knee show the distal end of the stem had perforated the medial femoral condyle, reaching subcutaneous tissue through the knee joint (c), (d).
CRIOR2014-840267.001.jpg
PMC4094698_02_CRIOR2014-840267.001.jpg
fig1
The femorotibial joint showed a large osteochondral defect (3 cm in diameter) in the medial femoral condyle, as suggested by radiographic findings (Figure 1).
A photograph of the implanted total femur prosthesis (a). Polypropylene meshes wrapped around the prosthesis to create attachment of the surrounding soft tissue (b).
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fig3
Some residual eggshell-like femoral cortex, together with the muscle attachment, was preserved and sutured with a polypropylene mesh wrapped around the total femur prosthesis (Figure 3).
Postoperative radiographs of the left femur showing the total femur prosthesis as implanted. (a) Anteroposterior view. (b) Lateral view.
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Cup reconstruction was performed using a KT-plate with structural bulk and morselized bone allograft (Figure 4).
Histologic findings of the scar tissue. There are numerous foamy macrophages but no evidence of acute inflammation. Scale bar: 50 mum.
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PMC4094698_03