Total condylar unipolar expandable prosthesis for proximal tibia malignant bone tumors in early childhood

Wide resection and reconstruction of tumors of the proximal tibia in the pediatric population are challenging procedures. The use of hinged, expandable prostheses may cause early closure of the distal femoral growth plate, which may increase the risk of limb discrepancy already present in this population. Between 1991 and 2001, 2 girls and 1 boy, aged 6, 6, and 4 years, respectively, were diagnosed with osteosarcoma of the proximal tibia and treated with wide resection and reconstruction with a condylar unipolar expandable tibial prosthesis. A press-fitted technique was used for component insertion. All patients received neoadjuvant and adjuvant chemotherapy. Radiographic and functional follow-up took place at least once a year for a minimum of 4 years. Adequate pain control, limb-length equality, and acceptable function were obtained in all patients. One patient presented with significant range of motion reduction (0°- 30°) in the affected knee. Limb lengthening was performed as needed to maintain balanced limb length. All patients had a good Musculoskeletal Tumor Society category score. No complications occurred in terms of component loosening or infection. One patient died shortly after 4-year follow-up because of doxorubicin-induced leukemia. Currently used hinged, expandable prostheses can jeopardize the unaffected distal femoral growth plate. This article describes a technique of reconstruction that spares the distal femoral growth plate. Adequate limb length can be expected with acceptable functional outcome. However, it is imperative to keep in perspective the expectations of the physician, the physician's team, the patient, and the patient's family.