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Received Aug 29, 2017; Accepted Dec 13, 2017
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
Paediatric bone sarcoma frequently arises in the metadiaphyseal regions of the distal femur or the proximal tibia. Wide resection can include the growth plate, and there will be a leg-length discrepancy by skeletal maturity. In the past, amputations in the very young patients or multiple revision surgeries were performed to address the leg-length discrepancy [1].
In 1976, the first expandable prostheses (synonyms: extendible or growing prostheses) were introduced, allowing minimally invasive lengthening via a small skin incision [2]. Still, general anaesthetics and surgical interventions were required, which ultimately increased the risk of infection and the loss of prosthesis [3], so that noninvasively expandable prostheses are now considered to be the gold standard in paediatric limb-salvage surgery [4]. Different types of noninvasive lengthening mechanisms are currently available and can be applied in an outpatient setting [1, 2, 5, 6].
To implant a growing prosthesis, at least 3-4 cm of growth has to be expected for the child until skeletal maturity [7–9]. Furthermore, expandable prostheses require a minimal resection length between 123 and 170 mm depending on the prosthesis type and a sufficient bone diameter, limiting its use in very young children [6, 10]. There is no consensus on the minimum age for the implantation of a growing prosthesis [4, 6, 8, 10, 11].
Our survey aimed to clarify the indications for implantation of a growing prosthesis in bone sarcoma patients by conducting a survey among experts in orthopaedic oncology. Furthermore, we aimed to identify alternative methods other than expandable prostheses to compensate for limb-length inequality.
2. Materials and Methods
A ten-minute web-based survey (Question Pro©) was distributed via email to 98 active orthopaedic surgeons of the European Musculo-Skeletal Oncology Society (EMSOS) (Supplementary Materials (available here)). Nonorthopaedic members were not invited to participate in the survey. Participants who stated via email that they are retired or do not operate on children were excluded from the survey (2 surgeons). Forty-four invited orthopaedic surgeons from thirteen European countries responded to the survey (participation rate 45%), and the completion rate was 93%.