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J Bone Joint Surg Br ; 94(3): 425-30, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22371554

ABSTRACT

In skeletally immature patients, resection of bone tumours and reconstruction of the lower limb often results in leg-length discrepancy. The Stanmore non-invasive extendible endoprosthesis, which uses electromagnetic induction, allows post-operative lengthening without anaesthesia. Between 2002 and 2009, 55 children with a mean age of 11.4 years (5 to 16) underwent reconstruction with this prosthesis; ten patients (18.2%) died of disseminated disease and one child underwent amputation due to infection. We reviewed 44 patients after a mean follow-up of 41.2 months (22 to 104). The mean Musculoskeletal Tumor Society score was 24.7 (8 to 30) and the Toronto Extremity Salvage score was 92.3% (55.2% to 99.0%). There was no local recurrence of tumour. Complications developed in 16 patients (29.1%) and ten (18.2%) underwent revision. The mean length gained per patient was 38.6 mm (3.5 to 161.5), requiring a mean of 11.3 extensions (1 to 40), and ten component exchanges were performed in nine patients (16.4%) after attaining the maximum lengthening capacity of the implant. There were 11 patients (20%) who were skeletally mature at follow-up, ten of whom had equal leg lengths and nine had a full range of movement of the hip and knee. This is the largest reported series using non-invasive extendible endoprostheses after excision of primary bone tumours in skeletally immature patients. The technique produces a good functional outcome, with prevention of limb-length discrepancy at skeletal maturity.


Subject(s)
Bone Lengthening/instrumentation , Bone Neoplasms/surgery , Lower Extremity/surgery , Prostheses and Implants , Adolescent , Bone Lengthening/methods , Child , Child, Preschool , Female , Femur/diagnostic imaging , Femur/surgery , Follow-Up Studies , Growth , Humans , Knee Joint/physiopathology , Leg Length Inequality/etiology , Leg Length Inequality/prevention & control , Limb Salvage/methods , Male , Prosthesis Design , Prosthesis Implantation/adverse effects , Prosthesis Implantation/methods , Radiography , Range of Motion, Articular , Reoperation/methods , Tibia/diagnostic imaging , Tibia/surgery , Treatment Outcome
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