Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table to facilitate access to the lateral aspect of the distal femur.

Anatomical surgical approach:  A lateral approach to the distal femur was utilized. The incision was made over the previous surgical scar, extending proximally and distally as needed to expose the hardware. Subperiosteal dissection was performed to access the lateral plates, which were removed. Radical debridement of infected tissue was carried out, followed by placement of a provisional cement spacer.

The surgeon noted significant purulence and necrotic tissue at the site of infection. Thorough irrigation and debridement were performed. The intramedullary canal was cleaned using the RIA system 2. A temporary spacer with bone cement was placed to maintain limb length and alignment while addressing the infection.

Postoperative protocol:   Postoperatively, the patient was managed with a monolateral external fixation device for bifocal bone transport. Tricalcium phosphate was used to fill the bone defect. Antibiotic therapy was adjusted based on culture results.

Follow up:   Not specified.

Orthopaedic implants used:   Provisional cement spacer, monolateral external fixation system, tricalcium phosphate.