WOFAPS 2025 8th World Congress of Pediatric Surgery

Wenhao Chen

Children's Hospital, Zhejiang University School of Medicine

Background

Osteosarcoma is the most common primary malignant bone tumor in children and adolescents, frequently affecting the lower extremities. Wide resection combined with endoprosthetic reconstruction remains a critical limb-salvage strategy, yet long-term outcomes, particularly in young patients, warrant further evaluation. This study analyzes early functional and oncological outcomes in a small cohort undergoing this procedure.

Methods

A retrospective review was conducted on six patients (1 male, 5 females; mean age 13.2 years) diagnosed with lower extremity osteosarcoma between 2020 and 2022. Surgical management included wide tumor resection followed by modular endoprosthetic reconstruction: 2 cases of proximal femoral (hip) replacement and 4 cases of distal femoral (knee) replacement. Perioperative chemotherapy and rehabilitation were standardized. Outcomes were assessed via the Musculoskeletal Tumor Society (MSTS) scoring system, complication rates, and survival analysis over a 24-month follow-up period.

Results

At two-year follow-up, four patients (66.7%) remained disease-free with a mean MSTS score of 22.5 (range 18–25), indicating satisfactory functional recovery. Two patients (33.3%) experienced metastatic recurrence at 2 and 8 months postoperatively, leading to mortality. Complications included one case of superficial surgical site infection and one case of transient periprosthetic joint instability, both resolved with intervention. No aseptic loosening or mechanical failure was observed. A case of 12 years old male with femoral osteosarcoma is showed in Figure 1.

Conclusions

Despite the challenges of small sample size, early results suggest that endoprosthetic reconstruction following wide resection provides viable limb salvage in pediatric and adolescent osteosarcoma, with acceptable functional outcomes. However, high rates of metastatic recurrence underscore the need for stringent surveillance and multidisciplinary management. Larger cohorts and extended follow-up are essential to refine surgical protocols and adjuvant therapies.