Extendable prostheses for the treatment of malignant bone tumors in growing children

Purpose of review: Children with bone sarcomas endure radical surgical procedures often followed by demanding reconstructions. In the past, surgical management was limited to amputation or rotation plasty, and limb salvage was attempted only near adulthood. Over the past 20 years, significant advances in prosthetic designs have transformed limb lengthening into a relatively minor procedure that can be accomplished at the physician's office or in an outpatient setting. This review highlights the most important innovations in the field of extendable prostheses. Recent findings: Recent technological innovations have reduced risks and complications, and functional outcomes are now equivalent to those of limb preservation surgery in adults. The fields of design and engineering of prostheses have matured, and several high-quality devices are available to address any situation. Summary: The tools available today allow us to maintain adequate function and cosmesis in most cases. The ideal age at which an expandable prosthesis can be placed is still debated, however. With less invasive expansion procedures and more reliable mechanical devices, limb salvage under the age of 10 may become a more viable option. Nevertheless, these procedures should be performed by experienced surgeons and at institutions suited to address potential complications in the growing child.