J Korean Med Sci.  2009 Apr;24(2):350-353. 10.3346/jkms.2009.24.2.350.

Loss of Distal Femur Combined with Popliteal Artery Occlusion: Reconstructive Arthroplasty Using Modular Segmental Endoprosthesis: A Case Report

• Kang ST
• Hwang CH
• Kim BH
• Sung BY

• KMID: 1779145
• DOI: http://doi.org/10.3346/jkms.2009.24.2.350

Abstract

Severe injury to the knee and the surrounding area is frequently associated with injury to ligaments of the knee joint and structures in the popliteal fossa. This case involved a popliteal artery occlusion, severe bone loss of distal femur, loss of collateral ligaments, and extensor mechanism destruction of the knee. Initially, prompt recognition and correction of associated popliteal artery injury are important for good results after treatment. After successful revascularization, treatment for severe bone loss of distal femur and injury of the knee joint must be followed. We treated this case by delayed reconstruction using modular segmental endoprosthesis after revascularization of the popliteal artery. This allowed early ambulation. At 36 months after surgery, the patient had good circulation of the lower limb and was ambulating independently.

Keyword

Popliteal Artery; Arthroplasty; Endoprosthesis

MeSH Terms

*Arthroplasty, Replacement, Knee
Femur/*injuries/radiography/*surgery
Humans
Internal Fixators
Knee Injuries/*surgery
Knee Joint/surgery
Male
Middle Aged
Popliteal Artery/*injuries/radiography/*surgery

Figure

• 

  Fig. 1 (A) AP radiograph shows the severe comminuted fractures of the femur, tibia and patella, and severe loss of distal femoral bone. (B) Angiography demonstrates the complete occlusion of popliteal artery near to plateau of the tibia.

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  Fig. 2 External fixator crossing the knee joint was applied and antibiotics-mixed cement beads were inserted into the defect of the distal femur.

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  Fig. 3 An intraoperative photograph shows the modular segmental endoprosthesis, MUTARS® (Implantcast, Buxtehude, Germany) in position at the reconstructive arthroplasty.

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  Fig. 4 (A) Patellar tendon augmentation using a semitendinosus allograft in a figure-of-eight pattern. (B) Rotational flap of medial head of gastrocnemius.

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  Fig. 5 (A) Postoperative AP and (B) lateral radiographs at 36 months after reconstructive arthroplasty shows good alignment of the components and extracortical bone bridging.

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