Total Femoral Replacement as a Salvage Procedure for a Periprosthetic Fracture After Multiple Previous Femoral Reconstructions: A Case Report.

BACKGROUND Periprosthetic femoral fractures and complications after joint replacement pose serious therapeutic challenges, especially in older patients with multiple comorbidities. In cases where conventional stabilization and revision procedures fail, implantation of a total femoral replacement (TFR) prosthesis may provide a limb-salvage option. CASE REPORT We present the case of a 77-year-old woman with multiple comorbidities who underwent repeated treatment for fractures and complications involving the left femur over a 20-year period. Due to poor bone quality resulting from multiple previous fractures, she underwent implantation of an oncologic knee resection prosthesis (megaprosthesis), which was complicated by a periprosthetic fracture 19 years later, requiring emergency treatment. Following failure of proximal femoral plate fixation (approximately 4 months after emergency treatment), a total femoral prosthesis was implanted. Postoperatively, recurrent hip dislocations were managed with implantation of a dual-mobility acetabular cup followed by further revision surgery to restore hip stability and optimize biomechanics. Despite numerous complications, the patient regained mobility and is able to ambulate independently with a rehabilitation walker. TFR can be an effective limb-salvage option in complex cases of periprosthetic fractures. CONCLUSIONS In this case, TFR restored mobility, enabled the patient to regain lower limb function, and improved overall quality of life by eliminating chronic leg pain. At the 12-month follow-up, the patient was able to ambulate independently with a walker. These findings suggest that TFR can be an effective limb-salvage procedure in older patients with a history of multiple fractures.