[Growing prostheses for reconstruction of lower limb defects in children].

OBJECTIVE

Bone defect reconstruction with growing prostheses after resection of malignant bone tumors using the technique of extendable prostheses.

INDICATIONS

Limb salvage surgery after resection of primary malignant bone tumors in the growing skeleton for expected leg length deficiencies > 4 cm.

CONTRAINDICATIONS

Palliative tumor resection, infection, systemic metastases at the time of diagnosis, social contraindications, lack of compliance of the patient and/or family.

SURGICAL TECHNIQUE

Wide resection of the tumor with resection of the biopsy location. Reconstruction with the growing prosthesis. Planned lengthening operations.

POSTOPERATIVE MANAGEMENT

Mobilization with crutches, weight bearing or partial weight bearing according the prosthesis' fixation. Chemotherapy as defined in the chemotherapy protocol. Planned minimally invasive lengthening or noninvasive lengthening according to the type of growing module.

RESULTS

Since 1969, more than 8,632 patients have been registered in the Vienna Bone and Soft Tissue Tumor Registry. Of these, 691 patients suffered from osteosarcoma and 243 from Ewing's sarcoma. A total of 513 patients were < 18 years of age (54.4%). Since 1987, 71 patients have been treated with growing prostheses: 13 patients died of disease, and 44 patients reached maturity. The overall 5- and 10-year survival were 84% and 77%, respectively. The patient group consisted of 26 girls and 18 boys, mean age at surgery 10 ± 3 years. The diagnosis was 34 osteosarcoma and 10 Ewing's tumors. The patients had a mean of 4 ± 3 elongation procedures to reach an elongation of 72.5 ± 53.45 mm. The average elongation per procedure was 14.83 ± 4.6 mm.