Knee Hemiarthroplasty as a Reconstructive Option for Distal Femoral Sarcoma in Skeletally Immature Patients: Mid-Term Outcomes

Articles in Press

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain

2 Department of Orthopedic Surgery, Hospital Regional Universitario de Málaga, Málaga, Spain

3 Department of Orthopedic Surgery, Hospital Universitario de Getafe, Madrid, Spain

4 Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain.

5 Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

10.22038/abjs.2025.91379.4139

Abstract

Background: Limb-salvage procedures in pediatric patients with malignant bone tumors around the knee are surgically challenging due to the need for skeletal growth preservation and long-term functional demands. Hemiarthroplasty has emerged as a potential solution when other reconstruction options are limited or unfeasible.

Methods: We present a retrospective case series of three skeletally immature patients (ages 5-7) with high-grade malignant tumors of the distal femur. All underwent wide tumor resection followed by reconstruction using a hemiarthroplasty. Functional outcomes were assessed using the Enneking scoring system. Follow-up ranged from 3 to 5 years.

Results: All patients achieved limb preservation with good early functional recovery. The mean Enneking functional score was 23/30 (range, 21-25). Two patients remain disease-free with stable implants at the latest follow-up. One patient experienced pulmonary relapse and died 4 years after surgery. No local recurrences or mechanical implant failures were observed.

Conclusion: Hemiarthroplasty is a viable and cost-effective reconstructive option in pediatric patients with distal femoral sarcoma, particularly in settings where expandable endoprostheses are unavailable or contraindicated. Mid-term outcomes demonstrate acceptable oncologic safety and functional results. Larger studies are needed to validate its role as a standard reconstructive technique.

Level of evidence: IV.

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Main Subjects

The Archives of Bone and Joint Surgery

Articles in Press, Accepted Manuscript
Available Online from 03 May 2026

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History

  • Receive Date: 21 September 2025
  • Revise Date: 02 November 2025
  • Accept Date: 03 November 2025

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