Functional and Oncological Outcomes of Distal Femoral Reconstruction in Young Children: A Systematic Review and Meta-Analysis Publisher



Jamshidi K ; Zareie B ; Mokhtari M ; Khabiri S S
Source: Journal of Children's Orthopaedics Published:2026

Abstract

Purpose: Compare functional, oncologic, and complication outcomes of distal femoral reconstruction after malignant tumor resection in children <12 years, in whom adult implants are unsuitable. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic review and meta-analysis of PubMed, Embase, Scopus, Web of Science, and Cochrane (inception–January 1, 2025). Eligible studies reported outcomes for expandable or non-expandable prostheses, osteoarticular allograft, allograft–prosthetic composite, epiphyseal-preserving reconstruction, rotationplasty, arthrodesis, spacers, or amputation. Random-effects models pooled means/proportions; risk of bias was assessed using the Newcastle–Ottawa Scale; and certainty was assessed using GRADE. Results: Forty-one studies (n = 1186) met criteria. Pooled mean Musculoskeletal Tumor Society was 24.9/30 (95% confidence interval, 23.9–25.9; I2 = 97%). Biological joint-preserving methods and rotationplasty tended to yield the highest function; arthrodesis and amputation were lower. Local recurrence was 5.2% (95% confidence interval, 3.3–7.1) without differences between techniques. Five-year overall survival was 81.6% (76.6–86.6); epiphyseal-preserving reached 93.3%, expandable prostheses 79.0% (contextual, not causal). Complications differed: expandable prostheses had reoperation rates of 57.2% and mechanical failure of 42.3%; osteoarticular allograft had a fracture rate of 27.4% and failure rate of 37.5%; allograft–prosthetic composite had a failure rate of 24.4% and nonunion rate of 13.5%; and arthrodesis had the fewest complications. Deep infection was 6.7%. GRADE certainty was as follows: high for local recurrence; moderate for 5-year survival and infection; and low for function and reoperation/failure (heterogeneity, retrospective design). Conclusions: Reconstruction should be individualized, prioritizing function and complication risk; oncologic outcomes appear driven by tumor biology/systemic therapy. Heterogeneity and inconsistent failure definitions limited cross-technique comparisons and precluded pooled implant survival. Significance of study: Our pooled estimates offer practical reference points for counseling families about function and complications across reconstruction options in children aged <12 years while highlighting priorities for standardized reporting and coordinated prospective research. © The Author(s) 2025. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).