05/11/2025
Recently performed limb-salvage surgery in an 11-year-old boy with non-metastatic osteosarcoma of the left distal femur and fixed knee flexion contracture, post-neoadjuvant chemotherapy. Pre-op MRI showed the lesion abutting the neurovascular bundle; intra-operatively the tumor was partially encasing the bundle but could be carefully dissected free, permitting oncologically safe resection and reconstruction with a non-expandable distal femoral replacement. In our LMIC setting, cost and availability make non-expandable implants the only realistic option, and the pre-existing contracture meant accepting intentional shortening of ~0.5–1 cm to achieve a balanced limb.