{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T09:50:11Z","timestamp":1794304211000,"version":"4.9.0"},"reference-count":76,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Children's Orthopaedics"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>Compare functional, oncologic, and complication outcomes of distal femoral reconstruction after malignant tumor resection in children &lt;12\u2009years, in whom adult implants are unsuitable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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\u2013January 1, 2025). Eligible studies reported outcomes for expandable or non-expandable prostheses, osteoarticular allograft, allograft\u2013prosthetic composite, epiphyseal-preserving reconstruction, rotationplasty, arthrodesis, spacers, or amputation. Random-effects models pooled means\/proportions; risk of bias was assessed using the Newcastle\u2013Ottawa Scale; and certainty was assessed using GRADE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Forty-one studies (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20091186) met criteria. Pooled mean Musculoskeletal Tumor Society was 24.9\/30 (95% confidence interval, 23.9\u201325.9;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200997%). 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\u20137.1) without differences between techniques. Five-year overall survival was 81.6% (76.6\u201386.6); 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\u2013prosthetic 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).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance of study:<\/jats:title>\n                    <jats:p>Our pooled estimates offer practical reference points for counseling families about function and complications across reconstruction options in children aged &lt;12\u2009years while highlighting priorities for standardized reporting and coordinated prospective research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/18632521251398665","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T10:14:19Z","timestamp":1764152059000},"page":"57-73","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Functional and oncological outcomes of distal femoral reconstruction in young children: A systematic review and meta-analysis"],"prefix":"10.1177","volume":"20","author":[{"given":"Khodamorad","family":"Jamshidi","sequence":"first","affiliation":[{"name":"Department of Orthopedics, School of Medicine, Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bushra","family":"Zareie","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, School of Medicine, Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehrdad","family":"Mokhtari","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, School of Medicine, Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8906-7660","authenticated-orcid":false,"given":"Seyyed Saeed","family":"Khabiri","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran"},{"name":"Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-021-02995-1"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1302\/1863-2548.15.210095"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-34746-7_179"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20190625-02"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.104B10.BJJ-2022-0235.R1"},{"key":"e_1_3_3_7_2","article-title":"Long-term outcomes of rotationplasty patients in the treatment of lower extremity sarcomas with cost analysis","volume":"11","author":"Grimsrud C","year":"2020","unstructured":"Grimsrud C, Killen C, Murphy M, et al. 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