Cementotomy-Assisted Masquelet Technique: A Novel Method for Efficient Cement Extraction in Distal Femur Bone Defect Management

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Abstract
Summary: Masquelet's induced membrane technique has become a preferred method for treating distal femoral segmental bone loss in recent years because it is easier to perform, highly reproducible, and requires less monitoring compared with bone transport. It involves 2 surgical stages: placing a temporary cement spacer in the first stage, followed by filling the bone defect with bone grafts in the second stage. The ideal spacer should be large enough to fill the defect, extending 2–3 cm beyond the bone ends on either side to optimize the graft incorporation and reduce the risk of nonunion. In addition, the wide bone morphology of the distal femur requires a large volume of cement compared with diaphyseal regions to adequately fill the defect. Removal of large spacers can be challenging, especially with a plate in place, often needing significant force, which could damage the membrane and weaken the bone. Therefore, making deep axial cuts (cementotomy) in the cement spacer soon after filling the defect may facilitate easier removal without damaging the membrane and leaving any residual spacer, improving the chances of successful reconstruction. The current report presents the Masquelet technique combined with cementotomy and describes the advantages of it.

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