**10. Megaprosthesis**

The development of megaprosthesis in serious segmental bon defects happened thanks to the biomedical application of the metallurgic industry on the field of surgical oncology. The development of new prosthesis for large resections offered important opportunities to oncologic orthopaedic surgeons for the substitution of skeletal segment, as long bones of the upper and lower limbs and near joints.

Our experience in treatment of non-union and serious bone loss led us, sometimes, to confront with the reality of some failure, after futile attempts to reconstruct the bone, eve with the use of advanced technologies as biotechnologies in monotherapy or polytherapy. In case of patients with a NUSS score of 76–100, the severity of the lesions and the clinical conditions usually makes sure that the surgical options of arthrodesis and amputation are implemented. In front of these drastic situations, radiologic and clinic, and to patients that have no intention to consider the amputation as a solution of their problem, we decided to apply the principles of the oncologic surgery, trying to remedy at their extreme cases with a solution of massive prosthetic [50, 51].

Actually in commerce you can find modular prosthetic system able to replace the entire femur including hip and knee joints up to the distal third of the tibia.

This surgical instrument presents peculiar characteristics:


Thanks to these new implants are now possible to avoid the amputation or long and often inconclusive treatments of lengthening and arthrodesis of the ankle with external fixators. Those patients, being part of the fourth NUSS category, cannot have benefit nor from the application of biotechnologies because the real possibilities of regeneration of the subject are too compromised. Therefore in those patients, we think more opportune to do a substitution treatment that can give back the function to the patient rapidly rather than follow again useful reconstruction attempts. More studies will be carried out to value the efficacy and the longevity of those new instruments.

Case 2 (**Figures 5**–**7**)

**10. Megaprosthesis**

118 Advanced Techniques in Bone Regeneration

prosthetic [50, 51].

of the lower limbs,

action of this element.

of those new instruments.

Case 2 (**Figures 5**–**7**)

upper and lower limbs and near joints.

The development of megaprosthesis in serious segmental bon defects happened thanks to the biomedical application of the metallurgic industry on the field of surgical oncology. The development of new prosthesis for large resections offered important opportunities to oncologic orthopaedic surgeons for the substitution of skeletal segment, as long bones of the

Our experience in treatment of non-union and serious bone loss led us, sometimes, to confront with the reality of some failure, after futile attempts to reconstruct the bone, eve with the use of advanced technologies as biotechnologies in monotherapy or polytherapy. In case of patients with a NUSS score of 76–100, the severity of the lesions and the clinical conditions usually makes sure that the surgical options of arthrodesis and amputation are implemented. In front of these drastic situations, radiologic and clinic, and to patients that have no intention to consider the amputation as a solution of their problem, we decided to apply the principles of the oncologic surgery, trying to remedy at their extreme cases with a solution of massive

Actually in commerce you can find modular prosthetic system able to replace the entire femur

**•** It allows to be stretched according to the necessity on the way to restore the correct length

**•** It offers the possibility to be resurfaced by silver in septic cases, exploiting the bacteriostatic

Thanks to these new implants are now possible to avoid the amputation or long and often inconclusive treatments of lengthening and arthrodesis of the ankle with external fixators. Those patients, being part of the fourth NUSS category, cannot have benefit nor from the application of biotechnologies because the real possibilities of regeneration of the subject are too compromised. Therefore in those patients, we think more opportune to do a substitution treatment that can give back the function to the patient rapidly rather than follow again useful reconstruction attempts. More studies will be carried out to value the efficacy and the longevity

including hip and knee joints up to the distal third of the tibia.

**•** Stabilized with a tibial stem and a talocalcaneal stem locked with a screw,

This surgical instrument presents peculiar characteristics:

**•** Custom-made realized on radiologic images,

**Figure 5.** Clinical case 2—man, 46 years, initial injury following an accident on work in which suffered of comminuted tibial pilon fracture treated with synthesis with plate and complicated by septic condition. Comes to our attention with bone defect of the tibial distal epiphysis and severe bone loss with bone exposition and deep sepsis after the removal of the synthesis means and stabilization with external fixation. NUSS: 78 points. On the left X-rays and CT images, on the right intraoperative picture after the resection of the distal tibia, evident the severe skin loss that has been treated by covering flap.

**Figure 6.** X-rays post-op images that evidence the stabilization with external fixator and positioning of antibiotic ce‐ ment spacer with gentamicin and clindamycin (a), and after 3 months, resolved the septic condition, after the removal of the external fixator (b).

**Figure 7.** X-rays post-op images (a) after the implant of arthrodesing megaprosthesis of the distal leg (b) and clinical pictures (c) of the operated limb and of the skin condition.
