RESUMO
INTRODUCTION: Mega prosthesis is mainly used for the treatment of the oncologic patient whose limb underwent salvage surgery that caused the limb to lose significant bone or soft tissue. In recent years, mega prosthesis can also be used to treat non-oncologic patients. PRESENTATION OF CASE: We presented a case of a 40-year-old male with chief complain of pain on the right knee 5 months before admission. Four years previously, the patient sustained motor vehicle accident that fractured his head of femur dan distal femur. He underwent 2-staged surgery for his femoral head and distal femur. However, he presented a year later with signs of non-union and finally underwent mega prosthesis surgery on his distal femur. During his follow up, he experienced a fracture on his prosthesis 3 years later and was referred to our institution. Physical examination shows deformity and slight varus on the right knee, and limited range of motion. The patient then underwent implant revisions. DISCUSSION: After 12 months of post revision surgery follow-up, the patient was able to walk independently. Our patient has not had any sign or episode of failure after the follow up for 12 months. According to literature, the incidence of failure is mostly at 48-72 months post implantation. CONCLUSION: The problem for this patient maybe caused by the mechanical fatigue of the implant due to stress addressed to the implant. Our current technique of revisions procedure hopefully will enhance the power of the mega prosthesis for further usage.
RESUMO
INTRODUCTION: Severe Blount's disease results in progressive multiplanar deformity of the lower limb. There are varus, procurvatum, and internal tibia rotational deformity. Treatment varies for each patient, depending on age, magnitude of deformity, discrepancy, psychosocial factor, and surgeon's experience. The aim of treatment is to acutely correct deformity and realign the mechanical axis. We proposed a technique of step cut "V" Osteotomy which could achieve the aim of treatment safely and effectively. METHODS: Twenty-seven legs from eighteen patients were underwent Step Cut "V" Osteotomy technique in our institution from 2015 to 2017 to produce overvalgus correction. Eleven patients had bilateral deformities, and seven patients had unilateral deformity. All patients had mechanical axis deviation (MAD) away medially to the center of the knee, increase of tibiofemoral angle, and Drennan angle. Outcomes were recorded postoperatively such as infection, compartment syndrome, nerve palsy, range of motion, stability of knee ligaments, union time, early weight bearing and recurrence. RESULTS: From this Step Cut "V" Osteotomy, we can accurately measure the angle of correction we want to achieve preoperatively. Drennan angle and Tibiofemoral angle (TFA) of the patients improved with subsequent correction of interbal tibia rotation and procurvatum. No complication of compartment syndrome and nerve palsy were found. Patient could perform early mobilization, and weight bearing on second month after surgery because of strong fixation and good ligament stability. No significant postoperative infection occurred. Union time achieved in two to three months, but four legs from patients over 4 years old who underwent surgery experienced a recurrence. CONCLUSION: Step Cut "V" Osteotomy is a simple, safe and effective technique for acute correction of severe Blount's disease. And can produce an accurate correction, high union rate and early weight bearing with no complication as a result that would be achieved at the end of treatment.