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Expandable endoprosthesis for limb-sparing surgery in children: long-term results

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Purpose

Most children today with bone sarcomas undergo limb-sparing surgery. When treating children younger than 12 years of age, the result is significant limb length discrepancy (LLD). One of the solutions is the use of an expandable endoprosthesis.

Methods

A retrospective analysis of 38 skeletally immature patients with bone sarcoma of the lower limb in whom different types of expandable endoprostheses were used from January 1988 to December 2005 were included. All patients were under the age of 14 years. There were 26 osteosarcoma and 12 Ewing’s sarcomas. The data collected included the tumor characteristics, the surgical and other treatment modalities, complications and their treatment, and the final LLD and functional results.

Results

Fifty-five percent of the patients survived and had a mean follow-up of 113 months. All survivors reached skeletal maturity at the time of last follow-up. Seventy-one percent of the survivors had satisfactory function and 29% had a poor result. There were three secondary amputations due to local recurrence. Complications were documented in 58% of patients; the most common was infection that was diagnosed 56 times (primary 16% and secondary 84%). A significant correlation was found between function and final LLD (greater than 5 cm = inferior function), the number of complications, and the number of surgical procedures performed other than prosthesis elongation. The younger the patient was at definitive surgery, the shorter the time it took for the prosthesis to fail.

Conclusion

In order to improve results, the number of operations must be reduced. This can be achieved by the use of novel non-invasive expandable endoprostheses or biological reconstruction.

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Authors and Affiliations

  1. The National Unit of Orthopedic Oncology, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., 64239, Tel-Aviv, Israel

    Amit Dotan, Shlomo Dadia, Jacob Bickels, Alexander Nirkin, Gideon Flusser, Josephin Issakov, Yehuda Kollender & Isaac Meller

  2. Department of Pediatric Hematology Oncology, The Sheba Medical Center, Tel-Hashomer, Israel

    Yoram Neumann

  3. Center for Pediatric Hematology Oncology, Schneider Children’s Medical Center of Israel, Petach Tikvah, Israel

    Ian Cohen

  4. Department of Pediatric Hematology Oncology, Meyer Children’s Hospital, Rambam Health Care Campus, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

    Myriam Ben-Arush

Authors
  1. Amit Dotan
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  2. Shlomo Dadia
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  3. Jacob Bickels
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  4. Alexander Nirkin
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  5. Gideon Flusser
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  6. Josephin Issakov
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  7. Yoram Neumann
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  8. Ian Cohen
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  9. Myriam Ben-Arush
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  10. Yehuda Kollender
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  11. Isaac Meller
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Corresponding author

Correspondence to Isaac Meller.

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Dotan, A., Dadia, S., Bickels, J. et al. Expandable endoprosthesis for limb-sparing surgery in children: long-term results. J Child Orthop 4, 391–400 (2010). https://doi.org/10.1007/s11832-010-0270-x

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  • DOI: https://doi.org/10.1007/s11832-010-0270-x

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