Volume 4, Issue 1, Pages (March 2018)

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Volume 4, Issue 1, Pages 58-64 (March 2018) Biarticular total femur spacer for massive femoral bone loss: the mobile solution for a big problem Pablo Sanz-Ruiz, PhD, MD, Jose Antonio Calvo-Haro, PhD, MD, Manuel Villanueva-Martinez, PhD, MD, Jose Antonio Matas-Diez, MD, Javier Vaquero-Martín, PhD, MD Arthroplasty Today Volume 4, Issue 1, Pages 58-64 (March 2018) DOI: 10.1016/j.artd.2017.02.007 Copyright © 2017 The Authors Terms and Conditions

Figure 1 (a) Radiograph view showing right distal femoral pseudoarthrosis. (b) Three-dimensional computed tomography reconstruction. Arthroplasty Today 2018 4, 58-64DOI: (10.1016/j.artd.2017.02.007) Copyright © 2017 The Authors Terms and Conditions

Figure 2 Intraoperative views during femoral extraction. (a) Trochanteric osteotomy; (b) femoral extraction; (c) acetabular extraction; (d) massive defect after femoral extraction; and (e) resected femur. Arthroplasty Today 2018 4, 58-64DOI: (10.1016/j.artd.2017.02.007) Copyright © 2017 The Authors Terms and Conditions

Figure 3 Biarticular femur spacer preparation process. (a) Nail measurement; (b) measurement of cephalic nail offset; (c and d) preparation of the proximal part: note the perforations made (arrows) for anchoring the abductor muscles; (e and f) nail coating; and (g) preparation of the distal ball and socket joint with washing. Note the reanchoring of the abductor muscles (arrows). Arthroplasty Today 2018 4, 58-64DOI: (10.1016/j.artd.2017.02.007) Copyright © 2017 The Authors Terms and Conditions

Figure 3 Biarticular femur spacer preparation process. (a) Nail measurement; (b) measurement of cephalic nail offset; (c and d) preparation of the proximal part: note the perforations made (arrows) for anchoring the abductor muscles; (e and f) nail coating; and (g) preparation of the distal ball and socket joint with washing. Note the reanchoring of the abductor muscles (arrows). Arthroplasty Today 2018 4, 58-64DOI: (10.1016/j.artd.2017.02.007) Copyright © 2017 The Authors Terms and Conditions

Figure 4 (a) Final preparation of the tibial bed using acetabular drills; (b) definitive reduction; and (c) closing and covering of the spacer with vastus lateralis muscle. Arthroplasty Today 2018 4, 58-64DOI: (10.1016/j.artd.2017.02.007) Copyright © 2017 The Authors Terms and Conditions

Figure 5 Postoperative evaluation 48 hours after surgery. Radiograph control in (a) anteroposterior projection; (b) Lateral projection; and (c and d) Passive joint range. Arthroplasty Today 2018 4, 58-64DOI: (10.1016/j.artd.2017.02.007) Copyright © 2017 The Authors Terms and Conditions