External Fixation Assisted Intramedullary Total Femur Arthroplasty: A Case Report

Introduction Total femur replacement (TFR) is a salvage procedure for patients with multiple failed hip and knee arthroplasties and is associated with high complication rates. Intramedullary TFR has emerged as a technique to preserve critical soft tissue attachments; however, maintaining limb length, alignment, and rotation remains challenging. Case Presentation We describe a novel case of intramedullary TFR utilizing external fixation to address these technical challenges. A 64‐year‐old male with subsidence of a hinged knee tumor prosthesis to the level of the greater trochanter underwent intramedullary TFR. External fixation was applied to the residual femoral and tibial bones to maintain limb length, alignment, and rotation during revision knee arthroplasty and total hip arthroplasty. At 1‐year follow‐up, the patient demonstrated improved function without complication or infection. Conclusion Based on this case report, intramedullary TFR utilizing external fixation can be used to maintain critical aspects of the limb, such as neurovascular structures, soft tissues, and positioning the lower extremity, therefore easing many of the technical challenges of the procedure. This may allow for fewer surgical complications as the difficulty of the procedure is eased and better patient outcomes as the procedure may be completed with more precision.