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Long-term outcomes of non-invasive expandable endoprostheses for primary malignant tumors around the knee in skeletally-immature patients

Archives of Orthopaedic and Trauma Surgery (2021)Cite this article

Abstract

Introduction

Expandable endoprostheses are used to restore limb function and compensate for the sacrifice physis involved in carcinologic resection. Long-term outcomes of the last generation of knee “non-invasive” expandable endoprostheses are required. Objectives were to report on oncologic results of bone sarcoma resection around the knee with expandable endoprosthesis reconstruction and to compare the surgical outcomes of the “non-invasive” expandable endoprostheses used in our department.

Materials and methods

Retrospective study that included all children with bone sarcoma around the knee that underwent tumor resection reconstructed with non-invasive expandable prosthesis. Phenix–Repiphysis was used from 1994 to 2008 followed by Stanmore JTS non-invasive from 2008 to 2016. Survival and complications were recorded. Functional outcomes included Musculoskeletal Tumor Society (MSTS) score, knee range of motion, lower limb discrepancy (LLD).

Results

Forty children (Sex Ratio = 1) aged a mean 8.8 years (range, 5.6–13.8) at surgery were included in the study. There were 36 osteosarcoma and 4 Ewing sarcoma that involved 33 distal femur and 7 proximal tibia. Cohort (n = 40) consisted of 28 Phenix–Repiphysis and 12 Stanmore with a mean follow-up of 9.8 ± 5.8 years and 6.1 ± 3.1 years, respectively. Postoperative infection rate was 7.5% in the cohort (3 Repiphysis). Functional results were significantly better in the Stanmore group with a mean MSTS of 87.6 ± 5.4% and knee flexion of 112 ± 38°. At last follow-up, implant survival was 100% in Stanmore group, whereas all living Phenix–Repiphysis were explanted. Mechanical failure was the primary cause for revision of Phenix–Repiphysis. Limb length equality was noted in 79% patients with Phenix–Repiphysis and 84% with Stanmore at last follow-up.

Conclusion

Chemotherapy and limb-salvage surgery yield good oncologic outcomes. Expandable endoprostheses are effective in maintaining satisfactory function and lower limb equality. With improvements made in the last generation of “non-invasive” prostheses, implants’ survival has been substantially lengthened.

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Abbreviations

LLD:

Lower limb discrepancy

MSTS:

Musculoskeletal Tumor Society

EPR:

Expandable Protheses

NIEPR:

Non invasive Expandable Protheses

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  1. Pediatric Orthopedic Surgery Department, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, 149 rue de Sèvres, 75015, Paris, France

    Ruben Dukan, Eric Mascard, Tristan Langlais, Younes Ouchrif, Christophe Glorion, Stéphanie Pannier & Charlie Bouthors

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  1. Ruben Dukan
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All materials had been approved by the country's health agency. This retrospective study was approved by our local ethics committee.

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Dukan, R., Mascard, E., Langlais, T. et al. Long-term outcomes of non-invasive expandable endoprostheses for primary malignant tumors around the knee in skeletally-immature patients. Arch Orthop Trauma Surg (2021). https://doi.org/10.1007/s00402-020-03712-z

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  • DOI: https://doi.org/10.1007/s00402-020-03712-z

Keywords

  • Bone sarcoma
  • Expandable endoprostheses
  • Limb salvage surgery
  • Non-invasive