Expandable endoprostheses in malignant bone tumors in children: indications and limitations

Expandable endoprostheses can be an option after resection of malignant bone tumors of the lower extremity in children and adolescents not only to bridge the resultant surgical defect but also to correct a residual limb length discrepancy. Small intramedullary diameter and short residual bone segments, as well as stress-shielding, are intrinsic technical limitations of fully implantable reconstructive devices. As a consequence, until recently, repeated operative interventions to reconstruct the limb and compensate for subsequent absence of growth within the affected limb were required to compensate for continued growth of the contralateral limb. Innovative expandable endoprosthetic devices are now available to help achieve equal limb length at maturity. One common device is a conventional endoprosthesis that is lengthened using a telescopic module, whereas the "bioexpandable" system lengthens the remaining bone using a lengthening nail as a modular part of the endoprosthesis. Both systems are equipped with motor drives that electromagnetic waves activate transcutaneously. One advantage of the "bioexpandable" endoprosthesis is that with sequential lengthening, the proportion of residual bone shaft to prosthesis length increases, thereby diminishing host bone-endoprosthetic lever arm forces.