STANMORE CUSTOM-MADE EXTENDIBLE DISTAL FEMORAL REPLACEMENTSCLINICAL EXPERIENCE IN CHILDREN WITH PRIMARY MALIGNANT BONE TUMOURSO. S. Schindler, MD, Senior Registrar in Orthopaedic Surgery; S. R. Cannon, FRCS, Consultant Orthopaedic Surgeon; and T. W. R. Briggs, FRCS, Consultant Orthopaedic SurgeonBone Tumour Unit G. W. Blunn, PhD, Chief Deputy of Research Department of Biomedical Engineering, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK. Correspondence should be sent to Dr O. S. Schindler at 24 Blackwood Crescent, Edinburgh EH9 1QX, UK. The use of extendible distal femoral replacements is a relatively new treatment alternative for malignant bone tumours in growing individuals. Although their appearance was widely appreciated, questions about functional practicality and longevity remain unclear. With longer follow-up, advantages of immediate functional restoration and beneficial psychological aspects seem to be overshadowed by an increase in complications such as aseptic loosening, infection or prosthetic failure. We have reviewed 18 children with such tumours who were treated between 1983 and 1990 by custom-made Stanmore extendible distal femoral replacements. Four died from metastatic disease within 2.5 years of operation and two required amputation for local recurrence or chronic infection.
The remaining 12 patients were followed for a mean of 8.7 years (6 to 13.2). A mean total lengthening of 5.2 cm was achieved, requiring, on average, 4.3 operations. Using the Musculoskeletal Tumor Society rating score the functional result at review was, on average, 77% of the expected normal function, with seven patients achieving This article has been cited by other articles:
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80%. Revision of the prosthesis was required in ten patients, in six for aseptic loosening, at a mean of 6.2 years after the initial procedure. 
