Indications and Outcomes of a Tibial Turn-up Procedure: A Case Series and Review of the Literature

Background: Treatment options for distal femoral bone loss resulting from malignancy, infection, or trauma can be grouped into limb salvage techniques versus amputation. A vascularized osteomyocutaneous flap using the ipsilateral tibia—a tibial turn-up procedure—can be used to restore femoral length for high above-knee amputations in both the primary and revision setting. We report 3 patients treated with this procedure. Purpose: To describe the treatment algorithm and functional outcomes of patients who have undergone a tibial turn-up procedure and to highlight its viability when considering surgical options for the treatment of distal femoral primary bone and soft tissue malignancy and in cases of severe trauma, infection, or implant failure. Patients and Methods: Three patients ages 21 to 56 years old treated with tibial turn-up as a salvage procedure for failed limb sparing techniques were followed for 1.5 to 3.5 years postoperatively. One was treated for recalcitrant chronic distal femur osteomyelitis, 1 for aseptic loosening of distal femoral replacement, and 1 for infected distal femoral replacement. Radiographic and functional outcomes including prosthetic use, ambulatory status, and current activity level were reported. Results: At a minimum 1.5-year follow-up, all 3 patients achieved bony union and were ambulatory with prosthetics without the use of additional gait aids. Conclusions: Tibial turn-up is an effective treatment option in the setting of distal femoral bone loss and/or limb salvage complications, providing good functional outcomes with a single durable surgery.