Reconstruction of gouty massive bone defects using Masquelet technique combined with titanium mesh cage: a case report and review of the literature

Abstract Background Extensive bone defects induced by tophaceous gout in the midfoot and hindfoot are rare in clinical practice, and effective reconstruction of such defects remains a prominent therapeutic challenge. Case presentation The present case report describes successful clinical management of a 39-year-old Chinese female patient with a 20-year history of poorly controlled gout and concurrent polycystic ovary syndrome, which represents an atypical clinical presentation in young women. What distinguishes this case report is that the Masquelet technique combined with titanium mesh cage reconstruction was successfully applied to treat extensive non-infectious bone defects induced by tophaceous gout. To our knowledge, such an application has not been reported in previous literature on gouty arthropathy. The patient presented with progressive right midfoot deformity and limited ankle mobility; dual-energy computed tomography (DECT) confirmed that the total volume of tophi in the right foot was 275.89 cm 3 , with lesions involving the talus, navicular bone, cuneiform bones, and metatarsal bones. The total volume of tophi in both feet was approximately 479 cm 3 . After optimization of urate-lowering therapy, the patient completed two-stage surgical reconstruction on the right foot. The first-stage surgery involved thorough debridement of gouty tophi in the midfoot, followed by placement of a polymethyl methacrylate (PMMA) spacer to fill the bone defect. The second-stage surgery involved filling the bone defect with a mixture of autologous and allogeneic bone inside two titanium mesh cages (size: 12 mm × 80 mm for the hindfoot, 10 mm × 80 mm for the midfoot), and internal fixation with a plating system to reconstruct the continuity of the tibio-calcaneal–metatarsal structure and restore normal biomechanical alignment of the foot. At 6 months after the right second-stage surgery, imaging examinations showed complete bone fusion, stable internal fixation, and the patient achieved significant functional recovery without severe complications. At 1 year after the right second-stage surgery, the patient exhibited improved walking ability with no major adverse events, and the right ankle–hindfoot American Orthopedic Foot and Ankle Society (AOFAS) score increased to 76. Conclusions This case indicates that limb salvage for severe bone loss caused by gout can be achieved through the combined approach of systematic disease control, biological reconstruction, and mechanical stabilization, which is clinically feasible.