TY - JOUR
T1 - Surgical and functional outcomes after limb-preservation surgery for tumor in pediatric patients
T2 - A systematic review
AU - Groundland, John S.
AU - Ambler, Steven B.
AU - Houskamp, Daniel J.
AU - Orriola, John J.
AU - Binitie, Odion T.
AU - Letson, G. Douglas
N1 - Publisher Copyright:
© COPYRIGHT 2016 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED.
PY - 2016/2/2
Y1 - 2016/2/2
N2 - Background: Limb-salvage surgery and segmental reconstruction for the treatment of lower extremity osseous tumors in the pediatric population have been described in the literature, but there is little consensus regarding the optimal surgical treatment for this patient population. Methods: A systematic review of the literature was performed to identify studies focusing on limb-salvage procedures in pediatric patients who were managed with one of three reconstructions with use of a metallic endoprosthesis, allograft, or allograft-prosthesis composite. Data were segregated according to the excised and reconstructed anatomical location (proximal part of the femur, total femur, distal part of the femur, proximal part of the tibia) and were collated to assess modes of failure and functional outcomes of each reconstruction type for each anatomic location. Results: Sixty articles met the inclusion criteria; all were Level-IV evidence, primarily consisting of small, retrospective case series. Infection was a primary mode of failure across all reconstruction types and locations, whereas allograft reconstructions were susceptible to structural failure as well. The rate of failure in the pediatric population correlated well with previously published results for adults. The incidence of subsequent amputation was lower in the pediatric population (5.2%) than has been reported in adults (9.5%) (p 5 0.013). Meaningful growth of expandable metallic endoprostheses was reported in the literature, withan overall rate of leg-length discrepancy of 13.4% being noted at the time of the latest follow-up. The Musculoskeletal Tumor Society (MSTS) questionnaire was the most consistently used outcome measure in the literature, with average scores rangingfrom 71.0%to86.8%,dependingonreconstruction type and anatomic location. Conclusions: The current state of the literature detailing the surgical and functional outcomes of segmental reconstruction for the treatment of pediatric bone tumorsislimitedtoLevel-IV evidence andiscomplicated by under-segregation of the data by age and anatomical location of the reconstruction. Despite these limitations, pediatric limb-salvage surgery demonstrates satisfactory initial surgical and functional outcomes.
AB - Background: Limb-salvage surgery and segmental reconstruction for the treatment of lower extremity osseous tumors in the pediatric population have been described in the literature, but there is little consensus regarding the optimal surgical treatment for this patient population. Methods: A systematic review of the literature was performed to identify studies focusing on limb-salvage procedures in pediatric patients who were managed with one of three reconstructions with use of a metallic endoprosthesis, allograft, or allograft-prosthesis composite. Data were segregated according to the excised and reconstructed anatomical location (proximal part of the femur, total femur, distal part of the femur, proximal part of the tibia) and were collated to assess modes of failure and functional outcomes of each reconstruction type for each anatomic location. Results: Sixty articles met the inclusion criteria; all were Level-IV evidence, primarily consisting of small, retrospective case series. Infection was a primary mode of failure across all reconstruction types and locations, whereas allograft reconstructions were susceptible to structural failure as well. The rate of failure in the pediatric population correlated well with previously published results for adults. The incidence of subsequent amputation was lower in the pediatric population (5.2%) than has been reported in adults (9.5%) (p 5 0.013). Meaningful growth of expandable metallic endoprostheses was reported in the literature, withan overall rate of leg-length discrepancy of 13.4% being noted at the time of the latest follow-up. The Musculoskeletal Tumor Society (MSTS) questionnaire was the most consistently used outcome measure in the literature, with average scores rangingfrom 71.0%to86.8%,dependingonreconstruction type and anatomic location. Conclusions: The current state of the literature detailing the surgical and functional outcomes of segmental reconstruction for the treatment of pediatric bone tumorsislimitedtoLevel-IV evidence andiscomplicated by under-segregation of the data by age and anatomical location of the reconstruction. Despite these limitations, pediatric limb-salvage surgery demonstrates satisfactory initial surgical and functional outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85030458777&partnerID=8YFLogxK
U2 - 10.2106/JBJS.RVW.O.00013
DO - 10.2106/JBJS.RVW.O.00013
M3 - Review article
C2 - 27490132
AN - SCOPUS:85030458777
SN - 2329-9185
VL - 4
JO - JBJS reviews
JF - JBJS reviews
IS - 2
M1 - e2
ER -