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Introduction and importance Total femoral replacement (TFR) is a salvage surgical procedure that has been indicated mainly for oncologic indication to avoid lower limb amputation but has recently been indicated for non-oncological disorders. Case presentation We report the case of a 63-year-old male with chronic osteomyelitis of the left femur, severe pain and bone deformation, the risk of amputation in this patient was very high. The patient underwent total femur replacement (TFR) with a modular mega-prosthesis. TFR was conducted in two phases. The first one consists of femur resection followed by placement of antibiotic cement; and the second operation was performed after 7 weeks, in which a modular mega-prosthesis was implanted. After a 2-month rehabilitation period, the patient recovered basic ambulation without any complaint of pain or detectable residual infection. The 1-year follow-up was uneventful, with no residual pain or infection. The patient retains normal ambulation and daily function. Clinical discussion Chronic persistent osteomyelitis is a hard to manage non-neoplastic disorder that leads to amputation in severe cases. In such patients, TFR would be considered as a salvage therapy that could preserve the patient's anatomical integrity and ambulation. Conclusion To the best of our knowledge, this is the first case of TFR for treatment of chronic persistent osteomyelitis in Vietnam. While TFR are still mainly indicated for oncology patients, TFR is anticipated to be performed more frequently for non-oncological disorders where there are extensive femoral bone loss and risk of amputation.

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