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

Minotta-Quebradas, María-José; Moriel-Garceso, Diego-Jesús; Blasco-Smaranda, Iris-Elena; Cabello-Blanco, Juan; Ortiz-Cruz, Eduardo; RODRIGUEZ-MERCHAN, E. Carlos

doi:10.22038/abjs.2025.91379.4139

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

María-José Minotta-Quebradas ¹

Diego-Jesús Moriel-Garceso ²

Iris-Elena Blasco-Smaranda ³

Juan Cabello-Blanco ⁴

Eduardo Ortiz-Cruz ⁴

E. Carlos RODRIGUEZ-MERCHAN ⁵

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.

Keywords

hemiarthroplasty

distal femur

pediatric bone tumors

limb salvage

reconstruction

Enneking score

Subjects