Bone lengthening surgery for the treatment of children with osteosarcoma in the distal femur with severe limb-length discrepancy after different limb salvage surgeries:lessons learned and experiences
Objective By introducing the treatment process of bone lengthening surgery for severe limb-length discrepancy(LLD)in children with osteosarcoma of the distal femur after different limb salvage surgeries,this study explores the impact of different limb salvage surgeries on bone lengthening treatment,and summarizes experience and lessons learned.Methods A retrospective analysis was conducted on three children with osteosarcoma of the distal femur,two males and one female.They underwent initial limb salvage surgery at the age of 8,8,and 12,respectively.Two patients underwent allogeneic bone reconstruction with distal femoral tumor resection and preservation of the distal femoral epiphysis,while one patient underwent distal femoral tumor resection and reconstruction with a special hinged knee prosthesis which preserved proximal tibial epiphyseal.Long term follow-up after surgery,with follow-up time longer than 6 years,showed severe limb-length discrepancy in all 3 patients after epiphyseal closure.Bone lengthening surgery was performed to lengthen the lower limbs.Results Two patients who had reconstruction with allogeneic bone underwent bone lengthening surgery at the proximal end of the femur using a single arm external fixation bracket.The lengthening process was smooth,and the length of lower limbs was equal after the lengthening surgery.The patient who underwent hinged prosthesis replacement experienced loosening of the prosthesis and shortening of the femur and tibia 6 years after surgery.After removal of the loose prosthesis,a cement spacer was placed and a single arm external fixation bracket was used to lengthen the proximal femur bone.During the lengthening process,repeated infection of the pin site and deep tissue occurred.After satisfactory femoral lengthening,knee joint fusion was performed.The tibia was lengthened again using the Ilizarov circular stent after fusion,ultimately achieving equal length for lower limbs.Conclusions For distal femur osteosarcoma children with unclosed epiphyses,both biological and prosthetic reconstructions can lead to unequal length of the lower limbs after epiphyseal closure.However,biological reconstruction does not affect the growth potential of the proximal tibial epiphysis,and it also leaves sufficient bone mass for future femoral lengthening.
Bone lengtheningChildOsteosarcomaLower limb discrepancyLimb salvage surgery
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