Reconstruction options for pediatric bone tumors about the knee.

The surgical decisions involved with high-grade sarcoma surgery about the knee in pediatric patients are complicated. The orthopedic oncologist must have experience as well as a great deal of insight into the intricacies of each procedure and the wishes and demands of patients--not only while they are young but in into their adult life. It is difficult to predict the interests and vocation young patients will choose as their lives progress. However, if the patient qualifies as a candidate for limb preservation, the functional and cosmetic results obtained by limb preservation seem to be preferred. Amputation and rotationplasty should be reserved for patients who are not candidates for limb preservation or who are in an otherwise salvage situation. The prognosis for quality of life and limb after treatment for bone sarcomas has increased dramatically during the past decade. Survival approaching the 70% to 90% range can be expected, with >90% of those patients having limb preservation surgery. With further advancements in the biologic control of tissue healing, bioengineering, and prosthetic design and implantation, the future of these patients continues to be optimistic.