(P 479) EXPANDABLE ENDOPROSTHESES: SHOULD WE CONSIDER NARROWING OUR INDICATIONS? A SYSTEMATIC REVIEW OF THE LITERATURE AND COMPARISON OF OUTCOMES BY AGE GROUPS

Objective: Limb salvage with expandable endoprostheses (EEPRs) at the distal femur have been widely used to address limb post-resection length discrepancy (LLD). The objective of this study was to perform a systematic review of the literature to identify if outcomes differ among patients when stratified by age.

Methods: A review of PubMed/Medline and Cochrane databases was performed for peer-reviewed studies from 1997-2023 following PRISMA guidelines, with 17 studies meeting inclusion criteria. For reporting and analysis, patients were stratified by < 8, 8-10, 10-12, and >12 years old.

Results: Following review, 224 patients were included. Overall non-oncologic complication [NOC] (42%), prosthesis revision (30%), mortality (20.5%), and amputation (6%) rates were recorded, as well as mean MSTS scores (81%), lengthening (3.2cm), and LLD (1.5cm). Patients < 8 had lowest MSTS scores (75%) and highest LLD (2.4cm). Patients 8-10 had highest MSTS scores (84%), highest lengthening (4.2cm), and highest NOC rates (58%). Patients 10-12 had high MSTS scores (83%) and lowest NOC rates (33%). Patients >12 had lowest mean lengthening (2.4cm), high NOC rate (40%), and highest amputation rate (10%).

Conclusion: There are considerable limitations to this analysis given variability in reporting of this data. Mean MSTS scores and LLD outcomes for patients < 8 were poorest. These patients often require smaller components at greater risk for failure and need revision of expandable components prior to skeletal maturity – increasing complication risk. Patients >12 had mean lengthening slimly more than provided with a shoe lift and highest amputation rates. Patients 8-12 had highest MSTS scores and lengthening.