We present a case of 65 years old male patient who had presented to us with lytic lesion in the diaphysis of the femur. The lytic lesion had involved whole of the femur starting from 6 cm from the tip of greater trochanter to 6 cm proximal from the metaphyseal scar of the femur. Biopsy was planned and done for this patient which reported to be enchondroma on the first instance. Since the age and presentation was not matching so a repeat core biopsy was done which reported to be low grade chondrosarcoma.
Surgical resection of the lesion was then planned and patient was advised to get admitted. There was some time lag from the patient side and reported back to us with pathological fracture of the femur. Post fracture the tumor started enlarging aggressively. The resection was still the only option because he did not have any distant metastasis till then.
Since the involvement of the lesion was extensive so neither replacement with joint of either side (megaprosthesis) nor intercalary prosthesis was an option. Total femur replacement was planned and executed
The surgical resection started from the proximal aspect where arthrotomy and dislocation of hip was done leaving the abductors and vastus lateralis. The femur with the tumor was resected in the proximal aspect but as we went distal the involvement of the soft tissue was observed around the fracture site. The vessel was found to be stuck into the tumor at the fracture site. The help of plastic surgeon was then taken and clamping of the vessel was done both proximal and distal to the involved soft tissue site.
The tumor was then resected along with 8 cm of the vessel involved. The distal part of the femur was resected from the knee along with the collateral ligament. Vessels was then reconstructed with the help of PTFE (poly tetra flouro ethylene) (Braun).
The knee was then prepared and tibial component was then inserted. Appropriate length of femoral prosthesis was then assembled on table according to the size of femur resected and articulated with the tibial component. Hip abductors and flexors are then stitched back to the hole provided on the proximal aspect of the prosthesis. After confirming the distal vascularity, closure was then done over drains. Post- operative period was uneventful. The patient was mobilized after 6 weeks anticipating the healing of abductors and flexor of the hip. The patient was followed up for 3 months and was walking with the help of walker.