Functional and oncological outcomes of distal femoral reconstruction in young children: A systematic review and meta-analysis
Bibliographic record
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: = 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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.011 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".