Clinical Outcomes, Implant Survival, and Complications of Expandable Endoprostheses for Lower Limb Reconstruction in Skeletally Immature Patients with Bone Sarcoma: A Systematic Review and Single-Cohort Meta-Analysis.
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BACKGROUND: The management of malignant bone sarcomas in the lower extremities of skeletally immature children and adolescents remains a major challenge in orthopedic oncology. Expandable endoprostheses have become more popular over the last decades, but scientific data are limited. METHODS: To provide reliable data on functional outcomes, complications, and survival rates after this procedure, we conducted a systematic literature review and meta-analysis of prospective and retrospective studies. The primary objective was Musculoskeletal Tumor Society functional score. Secondary objectives included complications and survival rates. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool. RESULTS: A total of 1055 patients from 27 studies met the eligibility criteria. Overall methodological quality was moderate, with a mean MINORS score of 10.44. The mean age at surgery was 10.0 years (range 2.0-16.0), and the median follow-up was 5.44 years (range 1.7-24.0). Osteosarcoma accounted for 88.0% of cases and Ewing sarcoma for 10.4%. The pooled estimate of Musculoskeletal Tumor Society score was 82.9 (95% confidence interval [CI] 80.5-85.3). The pooled complication rate was 58.0% (95% CI 48.0-67.0), with no significant difference between minimally invasive and non-invasive expansion mechanisms. According to the Henderson/International Society of Limb Salvage classification, type III structural failures were the most frequent failure mode in both minimally invasive and non-invasive cohorts. The pooled 5-year overall survival rate was 76.0% (95% CI 54.7-89.2). CONCLUSIONS: This meta-analysis supports expandable endoprostheses as an effective limb-salvage option for skeletally immature patients with bone sarcoma, providing good functional outcomes and acceptable 5-year survival despite a high complication burden.