The management of Juvenile Tumour Systems implants following limb salvage surgery for bone sarcoma: A British consensus informing best practice and consistent care

The aim of this study was to gain a consensus for best practice of follow up of patients following limb salvage surgery with a Juvenile tumour Systems (JTS) extendible implant to benchmark and guide consistent care. A two-round modified Delphi study was conducted by paediatric sarcoma specialists. They identified 8 areas of follow up care that required consensus agreement. Statements were based around leg length measurement, long-leg X-Rays, joint range of movement, procedure within the lengthening appointment, physiotherapy, shoe raises, training, frequency of appointments. A pre-determined threshold of >70% for consensus, with a threshold of >60% being considered as ‘points to consider’. Sixteen professionals and manufacturers consented to be part of the consensus. A total of 63 statements were generated for the initial questionnaire, at the end of which 9 statements reached consensus. The remaining 54 statements were discussed and refined to 31 for the second questionnaire. Following two rounds of questionnaires and web conferences a total of 29 statements reached consensus. Paediatric sarcoma specialists have reached expert consensus to provide a framework for consistent follow up management of JTS implants, many of which could be generalised to other non-invasive growing implants. We would recommend that clinicians use these statements to ensure follow-up care is consistent.