Endoprosthetic Use in Pediatric and Adolescent Lower Limb Sarcoma Treatment.
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Endoprosthetic reconstruction has revolutionized the treatment of pediatric and adolescent lower limb sarcoma. These malignancies commonly affect the knee region, the site of the most actively growing physes of the lower limb. Modular and expandable endoprostheses have addressed the challenge of limb length discrepancy following physeal resection, with newer designs allowing noninvasive lengthening. However, decision making in pediatric tumor patients is complex, particularly given the potential number of reconstructive options, necessitating shared decision making between surgeons, patients, and families. The goal of surgery in achieving an R0 resection is nonnegotiable; reconstruction follows this. Endoprosthetic planning requires a nuanced approach involving both pediatric and arthroplasty orthopaedic considerations. Complication rates of endoprostheses are high and include infection, aseptic loosening, and those specific to certain anatomic locations. Future research should focus on standardized methods of outcome assessment, including patient-reported outcomes, to allow careful comparison across surgical techniques. Progress with regard to implant durability, complication reduction, and enhanced adjuvant therapies are the next steps in optimizing both survival and quality of life in this vulnerable population.