Limb reconstruction in children

Limb reconstruction in children after the resection of bone tumours is associated with the following particular issues:

  • Growth – predicted final leg length discrepancies of more than 3cm are most often addressed using an extendible implant, eg the Stanmore Juvenile Tumour System. The paper by Cool et al suggests how to calculate the expected growth if bone age is known.
  • Longevity of reconstruction – endoprosthetic reconstructions in children are inevitably associated with the need for revision – biological reconstructions may be preferred
  • Adaptation – children may be more able to adapt to loss of function than adults
  • Amputation – amputation in a child can lead to disproportionate limb length discrepancy at skeletal maturity, and trans-osseous amputations can overgrow and require revision. For this reason, amputations through joints may be preferred.
  • Radiotherapy – adjuvant radiotherapy can affect growth plates
  • Acetabular deformity – hemiarthroplasty of the hip is associated with subluxation as growth occurs, particularly for children under 11 years of age (1). A Collona arthroplasty of the acetabulum in which the acetabulum is reamed to deepen the socket may help. Otherwise a shelf osteotomy may be needed in later life.

(1)  van Kampen M, Grimer RJ, Carter SR, Tillman RM, Abudu A. Replacement of the hip in children with a tumor in the proximal part of the femur. J Bone Joint Surg Am. 2008 Apr;90(4):785-95.