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Surgical and Functional Outcomes After Limb-Preservation Surgery for Tumor in Pediatric Patients

A Systematic Review

Groundland, John S., MD, PT1,a; Ambler, Steven B., PT, DPT, MPH, CPH, OCS1,b; Houskamp, LT Daniel J., MD, MC, USN2,c; Orriola, John J.1,d; Binitie, Odion T., MD3,e; Letson, G. Douglas, MD3,f

doi: 10.2106/JBJS.RVW.O.00013
Evidence-Based Systematic Review
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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 = 0.013). Meaningful growth of expandable metallic endoprostheses was reported in the literature, with an 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 ranging from 71.0% to 86.8%, depending on reconstruction 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 tumors is limited to Level-IV evidence and is complicated 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.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopedics and Sports Medicine (J.S.G.), School of Physical Therapy & Rehabilitation Sciences (S.B.A), Shimberg Health Sciences Library (J.J.O.), USF Health Morsani College of Medicine, University of South Florida, 13330 USF Laurel Drive, MDC 90, Tampa, FL 33612

2Department of Orthopaedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134

3Sarcoma Department (O.T.B.) and Executive Vice President of Clinical Affairs (G.D.L.), H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612

aE-mail address for J.S. Groundland: jgroundl@health.usf.edu

bE-mail address for S.B. Ambler: sambler@health.usf.edu

cE-mail address for D.J. Houskamp: daniel.houskamp@med.navy.mil

dE-mail address for J.J. Orriola: jorriola@usf.edu

eE-mail address for O.T. Binitie: Odion.Binitie@Moffitt.org

fE-mail address for G.D. Letson: Douglas.Letson@Moffitt.org

Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated
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