A 45-year-old man came to us with a pathological fracture of the right femoral shaft, a fracture of the thigh bone that happened through a tumor, in this case a chondrosarcoma, a malignant tumor that forms cartilage. Three years earlier he had broken the neck of the same femur and had a hip replacement abroad.
X-ray at presentation: the hip replacement and the fractured femoral shaft.
A second X-ray view at presentation, showing the fracture.
A tumor growing fast
On the follow-up X-rays of his hip replacement, we noticed that the tumor was growing rapidly. A biopsy showed a grade 2 chondrosarcoma.
The plan, and why we changed it
Our plan was a total femur replacement, replacing the whole femur with a metal implant. Unfortunately, the patient was not covered for this implant and could not pay for it.
So we elected to do a biological reconstruction using his own bone. This is a well-described technique: the diseased bone is removed and the tumor in it is sterilized, either with radiation or with liquid nitrogen. We proceeded with liquid nitrogen. The video shows the freezing of the bone itself during the operation.
Video during surgery: freezing the removed bone in liquid nitrogen.
Rebuilding the femur
After the bone was sterilized, we reconstructed the femur and fixed it with plates and screws.
X-ray after the reconstruction: the plate and screws holding the femur.
X-ray after the reconstruction, near the knee.
X-ray after the reconstruction: the upper femur, with the hip replacement and the plate.
Risks and the result so far
This procedure carries a risk of non-union, where the reconstructed bone does not heal together. If that happens in the future, we will deal with it accordingly. Until now, the patient is progressing well, and fortunately there has been no recurrence of the tumor.
Cases are published with the patient's consent and without anything that identifies them. Results differ from patient to patient.
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