Introduction
Limb salvage is achievable in most patients (90%) with bone or soft
tissue sarcomas owing to chemotherapy and reconstructive surgery
advances. However, amputation is needed in some patients due to chronic
infection, tumor recurrence, and construct failure (1). Proximal
transfemoral amputations result in less energy-efficient walking,
increased oxygen consumption, and reduced walking speed (2,3).
Tibial turn-up plasty is a surgical alternative for severe femoral bone
defects, avoiding proximal above-knee amputations or hip
disarticulations to augment the functional length of the stump. The
surgical basis is to use the ipsilateral tibia as a pedicled autograft
or free flap, rotating the bone proximally 180ยบ (coronal or sagittal
plane) to the remaining femur or hip joint. The result is a longer
stump, optimizing prosthetic fitting for more efficient gait balance
during mobilization (4).
We herein report the case of a 46-year-old male with a history of
conventional high-grade osteosarcoma of the distal left femur who
underwent limb salvage with distal femoral endoprostheses. Several years
after the surgery, he developed an untreatable periprosthetic infection
with substantial femoral bone loss. The tibial turn-up plasty was
proposed as an alternative to a proximal above-knee amputation to
optimize prosthesis use and potentiate gait balance. The transfemoral
prosthesis was fitted 11 months after surgery. At the final follow-up,
the patient was ambulatory with a cane without complaints about
prosthesis fitting or pain.