Outcomes of oncologic arthroplasty in children and adolescents with malignant limb tumors: a systematic review

Background. Amputation was historically the primary surgical intervention for children with limb bone sarcomas. However, the development and refinement of chemotherapy and radiotherapy protocols, along with advances in surgical techniques and implants, have significantly altered the treatment landscape for these patients. Currently, limb-sparing oncologic arthroplasty is the preferred surgical approach for treating limb sarcomas in children. The aim of the systematic review is to analyse the outcomes of oncologic arthroplasty in children and adolescents. Methods. A comprehensive literature search was performed in Google Scholar, PubMed, ScienceDirect, and eLIBRARY databases focusing on the keywords “endoprostheses, tumors, children”, from 2000 to 2024. Data collection included patient demographics (number of patients, gender, age), follow-up period, disease diagnosis, tumor location, type of endoprosthesis, complications, functional outcomes based on the Musculoskeletal Tumor Society score (MSTS) in percentage, overall survival rates, and prosthesis survival rates. Results. The review included the data from 30 articles on a total of 792 patients aged 2 to 18 years, with 422 males and 370 females. The average age was 11.4 years, and the average follow-up period was 6.5 years. Osteosarcoma was the most common diagnosis, accounting for 716 (88.8%) cases, followed by Ewing sarcoma with 67 (8.3%) cases. Distal femoral arthroplasties were performed most frequently (573 cases, 71.1%), followed by proximal tibial arthroplasty (148 cases, 18.3%). The most commonly used type of endoprosthesis was the non-invasively extendable type (540 cases, 67%). A total of 756 complications were recorded, resulting in a complication rate of 96%. The complications were predominantly oncologic (188 cases, 25%) and pediatric orthopedic (166 cases, 22%). The 5-year and 10-year overall survival rates were 81.68% and 77.63%, respectively, with an average prosthesis survival rate of 53.93%. Conclusion. The data obtained indicate an extremely high frequency of complications during oncologic arthroplasty in children, mainly of an orthopedic profile, which requires analysis and development of measures to prevent them, as well as organizational solutions for the correction of these disorders.