A semi-conservative technique for femoral prosthesis fracture offers fast recovery and preserves bone stock.
When a femoral prosthesis fracture occurs, especially in young and active patients, it can present a significant surgical challenge. In some cases, the only alternatives appear radical. However, a recent technical study titled "Distal femoral megaprosthesis fracture treated by RescueSleeve MEGASYSTEM-C" offers a breakthrough solution.
This article summarises the innovative approach by Prof. Etienne Cavaignac and his team, offering an expert perspective on the treatment of complex prosthetic fractures.
To further explore advanced orthopaedic techniques, we invite you to read other studies by Professor Cavaignac, a leader in knee and sports surgery.
A femoral prosthesis fracture is a rare but severe complication that may occur after one or more revision knee arthroplasties, particularly in patients with distal femoral replacements. Such failure usually happens at the junction between the metaphyseal and diaphyseal components. Common causes include mechanical stress, long-term wear or trauma.
Femoral prosthesis fracture can lead to considerable pain, restricted mobility and difficulty bearing weight. It raises the complex issue of limb salvage, especially when the residual femoral bone stock is limited or when removing a well-fixed stem is not desirable.
Traditionally, treatment options include total femur replacement or complex femorotomy, both of which carry high morbidity and functional loss. Hence, identifying a technique that is both conservative and effective is vital in orthopaedic surgery.
In the case presented by Prof. Cavaignac, the solution involved a custom-made femoral sleeve designed to fit a well-fixed residual stem, avoiding the need to remove it. This sleeve, known as RescueSleeve MEGASYSTEM-C, was combined with a standard epiphyseal implant and a spacer, offering a personalised and bone-preserving reconstruction.
The success of this technique relied on meticulous preoperative planning, carried out in close collaboration with the implant manufacturer. EOS imaging was used to assess femoral length, bone quality and the extent of osteolysis. Based on these data, the custom sleeve was fabricated to fit perfectly over the fixed stem.
During the operation, the surgical team made a key decision to keep the existing metal rod (called the femoral stem) inside the patient’s thigh bone. This rod had been placed during a previous knee replacement surgery and was still firmly fixed to the bone. Removing it would have required cutting away more of the bone, which would have caused greater trauma and long-term consequences.
Instead of removing the well-fixed stem, the surgeons used a custom-made connecting piece: the RescueSleeve. This metallic sleeve was specially designed to fit snugly over the existing rod. It acted like an adapter, allowing the rest of the new implant (including the knee joint part) to attach securely to what was already in place.
To ensure the whole assembly was strong and stable, the sleeve was attached in two ways:
This approach avoided any need for further bone cutting (also called femoral resection), preserved as much of the patient’s original bone as possible and reduced the risk of complications.
After surgery, the results were excellent: the patient’s leg was straight and the same length as the other one, the knee was stable and the patient could move it through a full range of motion, from fully straight to fully bent. This showed that the new implant was functioning well and had been precisely positioned.
This technique offers an appealing option for patients with limited femoral stock, enabling surgeons to avoid more aggressive options like total femur replacement.
Using a custom connector for femoral prosthesis fracture presents multiple advantages:
In the case documented, the patient achieved full range of motion (0°–110°) by day three and was walking unassisted within months. The Knee Injury and Osteoarthritis Outcome Score (KOOS) improved from 12/100 to 80/100, a substantial clinical benefit.
This case is the first to describe the use of a custom-made connection sleeve for a distal femoral megaprosthesis fracture. It opens new avenues in orthopaedic reconstruction, particularly when bone stock conservation is paramount.
Several alternative strategies for similar fractures exist, such as:
However, these methods may carry increased complexity, infection risks or uncertain long-term outcomes. The custom sleeve approach strikes a balance between stability and conservation, making it a promising option in revision surgery.
While more studies are needed to evaluate the long-term survival and complication rates of this method, initial results are highly encouraging.
This innovative case illustrates how a custom RescueSleeve MEGASYSTEM-C can address complex femoral prosthesis fracture scenarios with minimal morbidity and optimal functional outcomes. This semi-conservative approach redefines the standard for limb salvage and revision knee arthroplasty.
For challenging knee cases, trust Professor Etienne Cavaignac’s expertise: where science, precision and patient care converge.
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