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Kokubu Y, Fujiwara T, Matsumoto Y, Endo M, Setsu N, Iida K, Nabeshima A, Nakashima Y. Older age at surgery and postoperative leg length discrepancy are risk factors for unfavourable patient-reported outcome measures of knee tumour endoprostheses following resection for musculoskeletal tumour of the lower limb. Bone Jt Open 2023; 4:906-913. [PMID: 38035606 PMCID: PMC10694779 DOI: 10.1302/2633-1462.412.bjo-2023-0125.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Aims To evaluate mid-to long-term patient-reported outcome measures (PROMs) of endoprosthetic reconstruction after resection of malignant tumours arising around the knee, and to investigate the risk factors for unfavourable PROMs. Methods The medical records of 75 patients who underwent surgery between 2000 and 2020 were retrospectively reviewed, and 44 patients who were alive and available for follow-up (at a mean of 9.7 years postoperatively) were included in the study. Leg length discrepancy was measured on whole-leg radiographs, and functional assessment was performed with PROMs (Toronto Extremity Salvage Score (TESS) and Comprehensive Outcome Measure for Musculoskeletal Oncology Lower Extremity (COMMON-LE)) with two different aspects. The thresholds for unfavourable PROMs were determined using anchor questions regarding satisfaction, and the risk factors for unfavourable PROMs were investigated. Results The thresholds for favourable TESS and COMMON were 64.8 and 70.4 points, respectively. Multivariate analysis showed that age at surgery (p = 0.004) and postoperative leg length discrepancy (p = 0.043) were significant risk factors for unfavourable TESS results, while age at surgery (p < 0.001) was a significant risk factor for unfavourable COMMON-LE results. Following receiver operating characteristic analysis, the threshold for both TESS and COMMON-LE was 29 years of age at surgery. Additionally, a leg length discrepancy of 8.2 mm was the threshold for unfavourable TESS. Conclusion Patients aged > 29 years at the time of surgery require appropriate preoperative counselling and adequate postoperative physical and socioemotional support. Reconstruction equivalent to the length of the resected bone can reduce the risk of functional disabilities in daily living.
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Affiliation(s)
- Yasuhiko Kokubu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshifumi Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Makoto Endo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nokitaka Setsu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keiichiro Iida
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Nabeshima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Rodrigues V, Szymanski C, Saab M, Maynou C, Tiffreau V, Wieczorek V, Dartus J, Amouyel T. Recovery of leg strength based on isokinetic testing after tumor resection and reconstruction with a modular rotating hinge knee system: Prospective cross-sectional study with a minimum follow-up of 24 months. Orthop Traumatol Surg Res 2023; 109:103631. [PMID: 37119875 DOI: 10.1016/j.otsr.2023.103631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND While modular reconstruction implants can be used to replace the bone lost after bone tumor resection, tumor excision from the neighboring soft tissues can lead to loss of strength and joint range of motion (ROM), which results in worse knee function. Functional recovery after total knee arthroplasty for osteoarthritis has been extensively documented. But few studies have evaluated the recovery after total knee reconstruction following tumor excision despite the fact that most of these patients are young and have high functional demands. We did a prospective cross-sectional study to: 1) compare muscle strength recovery around the knee with an isokinetic dynamometer after tumor excision and reconstruction with a modular implant to the healthy contralateral knee; 2) determine if the differences in peak torque (PT) in the knee extensors and flexors had a clinical impact. HYPOTHESIS Resection of soft tissues during tumor excision around the knee causes strength loss that cannot be fully recovered. METHODS The 36 patients who underwent extra- or intra-articular resection of a primary or secondary bone tumor in the knee area followed by reconstruction with a rotating hinge knee system between 2009 and 2021 were eligible for this study. The primary outcome was the ability to actively lock the operated knee. The secondary outcomes were the concentric PT during isokinetic testing at slow (90°/sec) and fast (180°/sec) speeds, flexion-extension ROM, Musculoskeletal Tumor Society (MSTS) score, the IKS, Oxford Knee Score (OKS) and KOOS. RESULTS Nine patients agreed to participate in the study, all of whom had regained the ability to lock their knee postoperatively. PT in flexion and extension on the operated knee was less than the healthy knee. The PT ratio for the operated/healthy knee at 60°/sec and 180°/sec in flexion was 56.3%±16.2 [23.2-80.1] and 57.8%±12.3 [37.7-77.4], respectively, which corresponded to a slow-speed strength deficit of 43.7% in the knee flexors. The PT ratio for the operated/healthy knee at 60°/sec and 180°/sec in extension was 34.3%±24.6 [8.6-76.5] and 43%±27.2 [13.1-93.4], respectively, which corresponded to a slow-speed strength deficit of 65.7% in the knee extensors. The mean MSTS was 70%±20 [63-86]. The OKS was 29.9/48±11 [15-45], the mean IKS knee was 149.6±36 [80-178] and the mean KOOS was 67.43±18.5 [35-88.7]. DISCUSSION Despite all patients having the ability to lock out their knee, there was an imbalance in the strength between opposite muscle groups: 43.7% strength deficit at slow-speed and 42.2% at fast speed for the hamstring muscles, and 65.7% at slow-speed and 57% at fast speed for the quadriceps muscles. This difference is considered pathological with an increased risk of knee injury. Despite this strength deficit, this joint replacement technique, which is free of complications, can preserve good knee function with acceptable knee joint ROM and satisfactory quality of life. LEVEL OF EVIDENCE III; prospective cross-sectional case-control study.
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Affiliation(s)
- Valentin Rodrigues
- Service d'orthopédie 1, hôpital Roger Salengro, 1, rue Emile Laine, 59800 Lille, France.
| | - Christophe Szymanski
- Service d'orthopédie 1, hôpital Roger Salengro, 1, rue Emile Laine, 59800 Lille, France
| | - Marc Saab
- Service d'orthopédie 1, hôpital Roger Salengro, 1, rue Emile Laine, 59800 Lille, France
| | - Carlos Maynou
- Service d'orthopédie 1, hôpital Roger Salengro, 1, rue Emile Laine, 59800 Lille, France
| | - Vincent Tiffreau
- Service de rééducation et réadaptation, hôpital Swynghedauw, 1, rue André Verhaeghe, 59800 Lille, France
| | - Valerie Wieczorek
- Centre hospitalier universitaire de Lille (CHU), CHU Lille - Eurasport, 413, avenue Eugène Avinée, 59120 Loos, France
| | - Julien Dartus
- Service d'orthopédie 1, hôpital Roger Salengro, 1, rue Emile Laine, 59800 Lille, France
| | - Thomas Amouyel
- Service d'orthopédie 1, hôpital Roger Salengro, 1, rue Emile Laine, 59800 Lille, France
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Johansen ML, Eriksrud O, Thorkildsen J, Norum OJ, Wisløff T, Taksdal I, Nilsen TS. Muscle strength characteristics following megaprosthetic knee reconstruction for bone sarcoma. Surg Oncol 2023; 48:101944. [PMID: 37062091 DOI: 10.1016/j.suronc.2023.101944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE To assess muscle strength characteristics in patients with resection and megaprosthetic reconstruction of the knee for bone sarcoma compared to age- and sex-matched controls. METHODS This was a cross-sectional, case-control study. Muscle strength characteristics for knee extension and -flexion were assessed isokinetically at three different joint velocities: 60, 120 and 180°/s, and by the rate of force development (RDFmax) in knee extension. The Toronto Extremity Salvage Score (TESS) was used in patients. RESULTS Eighteen patients (91.6 months postop.) and 18 controls were included. Relative to controls, patients generated maximal torques of 19%, 23% and 23% in knee extension at 60, 120 and 180°/s, respectively. For knee flexion, patients generated maximal torques of 58%, 53% and 60% at 60, 120, and 180°/s, relative to the controls. RDFmax of the operated leg was 2.75 ± 2.13 N/ms, 7.16 ± 4.78 N/ms for the non-operated leg, and 7.95 ± 4.29 N/ms for the controls. The mean TESS score was 84.0. CONCLUSION Patients reached approximately 20% of the maximal knee extension torque. In isometric assessments, they used double the amount of time to generate one-third of the maximal force compared to the controls despite good TESS scores.
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Affiliation(s)
- Merethe Lia Johansen
- Division of Cancer Medicine, Department of Clinical Service, Section for Cancer Rehabilitation, Oslo University Hospital, Oslo, Norway.
| | - Ola Eriksrud
- Institute of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Ole-Jacob Norum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Ingeborg Taksdal
- Division of Radiology and Nuclear Medicine, Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Tormod S Nilsen
- Institute of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
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van Kouswijk HW, van Keeken HG, Ploegmakers JJW, Seeber GH, van den Akker-Scheek I. Therapeutic validity and effectiveness of exercise interventions after lower limb-salvage surgery for sarcoma: a systematic review. BMC Musculoskelet Disord 2023; 24:216. [PMID: 36949467 PMCID: PMC10035240 DOI: 10.1186/s12891-023-06315-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/11/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND An increasing number of patients are surviving sarcoma after lower limb-salvage surgery (LSS) and are left with functional limitations. This systematic review aimed to determine the therapeutic validity and effectiveness of exercise interventions after lower limb-salvage surgery (LSS) for sarcoma. METHODS A systematic review was conducted using formal narrative synthesis of intervention studies (with and without control group) identified through PubMed, Embase, Cochrane Library, CINAHL, and PEDro databases. Studies were included if participants were treated with LSS for unilateral lower limb sarcoma and followed an exercise intervention using active exercise, physical training, or rehabilitation before and/or after surgery. This review's outcome measures were interventions' therapeutic validity, assessed using the CONTENT scale (0 to 9); methodological quality, identified using the Downs & Black checklist (0 to 28); interventions' effectiveness, assessed based on differences in outcome measures between intervention and control groups; and certainty of evidence, classified according to the GRADE approach. RESULTS Seven studies involving 214 participants were included. None of the included interventions were therapeutically valid (median 5, range 1-5). All but one study were of at least fair methodological quality (median 18, range 14-21). There was very low-quality evidence that exercise interventions resulted in increased knee range of motion (MD 10-15°) or compliance (MD 30%), and reduced functionality scores (MD -5%) compared to usual care. CONCLUSIONS We found overall low therapeutic validity of interventions, performed in overall low-quality studies. Combined with the very low certainty of evidence, the results prevent drawing valid conclusions on the interventions' effectiveness. Future studies should aim for uniformity among their methodological approaches and outcome measures, using the CONTENT scale as a template to avert insufficient reporting. TRIAL REGISTRATION PROSPERO CRD42021244635.
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Affiliation(s)
- H W van Kouswijk
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - H G van Keeken
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J J W Ploegmakers
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G H Seeber
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - I van den Akker-Scheek
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Rock K, Addison O, Gray VL, Henshaw RM, Ward C, Marchese V. Skeletal Muscle Measurements in Pediatric Hematology and Oncology: Essential Components to a Comprehensive Assessment. Children (Basel) 2023; 10. [PMID: 36670664 DOI: 10.3390/children10010114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
Children with hematologic and oncologic health conditions are at risk of impaired skeletal muscle strength, size, and neuromuscular activation that may limit gross motor performance. A comprehensive assessment of neuromuscular function of these children is essential to identify the trajectory of changes in skeletal muscle and to prescribe therapeutic exercise and monitor its impact. Therefore, this review aims to (a) define fundamental properties of skeletal muscle; (b) highlight methods to quantify muscle strength, size, and neuromuscular activation; (c) describe mechanisms that contribute to muscle strength and gross motor performance in children; (d) recommend clinical assessment measures; and (e) illustrate comprehensive muscle assessment in children using examples of sickle cell disease and musculoskeletal sarcoma.
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Rock K, Addison O, Gray VL, Nelson CM, Henshaw RM, York T, Ruble K, Marchese V. Quantifying muscle strength, size, and neuromuscular activation in adolescent and young adult survivors of musculoskeletal sarcoma: Identifying correlates and responses to functional strengthening. Knee 2023; 40:270-282. [PMID: 36529045 PMCID: PMC9898163 DOI: 10.1016/j.knee.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Medical and surgical treatment for musculoskeletal sarcoma (MSS) place survivors at risk for impairments in muscle properties including muscle strength, muscle size, and neuromuscular activation. The purpose of this study was to explore muscle properties, gross motor performance, and quality of life (QoL) and the changes in response to a 6-week functional strengthening intervention (PT-STRONG) in MSS survivors of childhood cancer (CCS). METHODS Eight lower extremity MSS CCS (13-23 years old) performed baseline testing and three completed PT-STRONG. Participants completed measurements of knee extension strength using handheld dynamometry, vastus lateralis (VL) and rectus femoris (RF) muscle thickness using ultrasonography at rest, and neuromuscular activation using electromyography during strength testing and a step-up task. Participants also completed gross motor and QoL assessments. RESULTS Compared with the non-surgical limb, MSS CCS had lower surgical limb knee extension strength, VL muscle thickness, and RF step-up muscle rate of activation (RoA). Compared with normative values, MSS CCS had decreased bilateral knee extension strength, gross motor performance, and physical QoL. Positive correlations among muscle strength, muscle thickness, and gross motor performance were identified. After PT-STRONG, MSS CCS had improvements in VL muscle thickness, VL and RF RoA duing step-up, gross motor performance, and physical QoL. CONCLUSIONS Positive association between larger muscle thickness with greater knee extension strength, and higher knee extension strength with better gross motor performance indicate that comprehensive physical therapy assessment and interventions that identify and target impairments in muscle properties to guide clinical decision making should be considered for MSS CCS into survivorship.
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Affiliation(s)
- Kelly Rock
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Odessa Addison
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vicki L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christa M Nelson
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert M Henshaw
- Department of Orthopedic Oncology, Children's National Hospital, Washington, DC, USA; Department of Orthopedic Oncology, Washington Cancer Institute at Medstar Washington Hospital Center, Washington, DC, USA; Department of Clinical Orthopedic Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Teresa York
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Hematology/Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Kathryn Ruble
- Department of Pediatric Oncology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Victoria Marchese
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA.
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Zhao YL, Zhang HR, Zhang JY, Hu YC. Postoperative Functional Assessment in Patients with Tumors Around the Knee Treated with Endoprosthetic Reconstruction: A Multicenter Retrospective Cohort Study. Technol Cancer Res Treat 2023; 22:15330338231181283. [PMID: 37321206 PMCID: PMC10278435 DOI: 10.1177/15330338231181283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/02/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES The restoration of as much normal function as possible has become an important goal following the endoprosthetic reconstruction. The objective of this study was to assess the functional outcome after endoprosthetic reconstruction for tumors around the knee and to explore prognostic factors of functional outcome. METHODS We retrospectively collected data on patients who underwent tumor prosthetic replacements consecutively. Musculoskeletal Tumour Society score and Toronto Extremity Salvage Score were used to assess the functional outcome at 1, 3, 6, 12, and 24 months after surgery. The logistic model was used to select factors that had potential predictive value for postoperative function. Potential prognostic factors included age, gender, tumor site, type of tumor, length of bone resection, type of prosthesis, length of prosthetic stem, chemotherapy, pathological fracture, and body mass index. RESULTS At the 24 months after surgery, the mean musculoskeletal tumor society (MSTS) score was 81.4% and the mean Toronto extremity salvage score (TESS) was 83.6%. At the last follow-up, 68% of patients and 73% of patients received perfect or good MSTS score and TESS score, respectively. The multivariate analysis according to ordered-logit model showed that age < 35 years, distal femoral prosthesis, and length of bone resection < 14 cm were independent prognostic factors of better functional outcome. CONCLUSIONS Endoprosthetic reconstruction may provide good functional results for most patients. Younger patients with distal femoral prosthesis and shorter resection of bone (on the premise of complete resection of tumor) are more likely to obtain satisfactory functional results after surgery.
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Affiliation(s)
- Yun-long Zhao
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
| | - Hao-ran Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jing-yu Zhang
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
| | - Yong-cheng Hu
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
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Gibbons JAB, Kahlenberg CA, Jannat-Khah DP, Christ AB, Goodman SM, Sculco PK, Figgie MP, Mehta BY. Tumors Constitute a Majority of Total Knee Arthroplasty in Patients <21 Years Old: A United States Nationwide Analysis. J Arthroplasty 2022; 38:836-842. [PMID: 36481288 DOI: 10.1016/j.arth.2022.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/09/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is rarely performed in patients under 21 years old, but the frequency of utilization of TKA in this population in the United States is not known. The purpose of this study was to evaluate trends in the use of TKA in patients <21 in the United States. Additionally, we aimed to determine the characteristics of these patients and the hospitals in which this procedure is performed. METHODS We retrospectively reviewed the Kids' Inpatient Database, a national weighted sample of all inpatient hospital admissions in the United States in patients <21 years of age. We used International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes to identify patients undergoing TKA from 2000 to 2019 and determine a primary diagnosis. Descriptive statistics were calculated using the appropriate sample weights. RESULTS The total weighted number of TKAs performed in patients <21 years from 2000 to 2019 was 1,535. There were 70.9% of TKAs performed for a primary diagnosis of tumor, and the use of TKA for malignant tumors has increased. In contrast, the use of TKA for inflammatory arthritis/juvenile idiopathic arthritis decreased significantly over the study period. The majority of TKAs were performed in urban teaching hospitals with a large bed size. CONCLUSION Approximately 1,535 TKAs have been performed in patients <21 years from 2000 to 2019 in the United States. The majority of these procedures were performed for reconstruction after resection of a malignant tumor. The rate of TKA for inflammatory arthritis/juvenile idiopathic arthritis has decreased over the past two decades.
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Affiliation(s)
| | | | - Deanna P Jannat-Khah
- Hospital for Special Surgery, New York, New York; Weill Cornell Medicine, New York, New York
| | - Alexander B Christ
- Keck Hospital of the University of Southern California, Los Angeles, California
| | - Susan M Goodman
- Hospital for Special Surgery, New York, New York; Weill Cornell Medicine, New York, New York
| | - Peter K Sculco
- Hospital for Special Surgery, New York, New York; Weill Cornell Medicine, New York, New York
| | - Mark P Figgie
- Hospital for Special Surgery, New York, New York; Weill Cornell Medicine, New York, New York
| | - Bella Y Mehta
- Hospital for Special Surgery, New York, New York; Weill Cornell Medicine, New York, New York
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Nashed J, Sundaresh A, Laurie C, Page C, Hines C, Ong SM, Black S, Heywood S. Gait, Function, and Strength Following Lower Limb Salvage Surgery for a Primary Malignant Bone Tumor: A Systematic Review. Rehabilitation Oncology 2022; 40:105-15. [DOI: 10.1097/01.reo.0000000000000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Idowu O, Oluwadiya K, Eyesan S, Nasser M, Maden M, Abudu A. The functional outcome after tumor resection and endoprosthesis around the knee: a systematic review. Acta Orthop Belg 2022; 88:73-85. [PMID: 35512157 DOI: 10.52628/88.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The evidence for the functional outcome of endo- prosthetic replacement (EPR) after tumour resection has been from few cohort studies. A scoping search revealed no systematic review on patient reported outcome measures after EPR around the knee. The purpose of this study was to evaluate the functional outcome of distal femoral and proximal tibial EPR after tumour resection. A systematic review was conducted using the PRISMA guidelines. The search identified 2560 articles from MEDLINE, EMBASE, CINAHL, and Web of Science. 36 studies satisfying the selection criteria were included for data synthesis. Pooled analysis was performed for homogenous studies. Narrative synthesis was performed for all the studies due to heterogeneity in methodological and statistical analysis. Amongst the overall patient population of 2930, mean ages ranged from 18-66 years and the mean follow up periods in the studies ranged from 12 - 180 months. The weighted mean functional outcome was similar for patients who had DFEPR and PTEPR. The functional outcome scores of Rotating Hinge Knee implants (RHK) were significantly greater than that for Fixed Hinge Knee implants (FHK). The weighted mean functional outcome scores were higher after cemented fixation and after primary EPR procedures. The current evidence suggests that functional out- come after EPR in the knee is good, and RHK implants are better than FHK implants. Functional outcome after primary EPR was significantly better than following revision EPR, and this underscores the importance of minimising complications at the primary surgery.
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11
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Nelson CM, Marchese V, Rock K, Henshaw RM, Addison O. Alterations in Muscle Architecture: A Review of the Relevance to Individuals After Limb Salvage Surgery for Bone Sarcoma. Front Pediatr 2020; 8:292. [PMID: 32612962 PMCID: PMC7308581 DOI: 10.3389/fped.2020.00292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 05/07/2020] [Indexed: 11/13/2022] Open
Abstract
Osteosarcoma and Ewing's sarcoma are the most common primary bone malignancies affecting children and adolescents. Optimal treatment requires a combination of chemotherapy and/or radiation along with surgical removal when feasible. Advances in multiple aspects of surgical management have allowed limb salvage surgery (LSS) to supplant amputation as the most common procedure for these tumors. However, individuals may experience significant impairment after LSS, including deficits in range of motion and strength that limit function and impact participation in work, school, and the community, ultimately affecting quality of life. Muscle force and speed of contraction are important contributors to normal function during activities such as gait, stairs, and other functional tasks. Muscle architecture is the primary contributor to muscle function and adapts to various stimuli, including periods of immobilization-protected weightbearing after surgery. The impacts of LSS on muscle architecture and how adaptations may impact deficits within the rehabilitation period and into long-term survivorship is not well-studied. The purpose of this paper is to [1] provide relevant background on bone sarcomas and LSS, [2] highlight the importance of muscle architecture, its measurement, and alterations as seen in other relevant populations and [3] discuss the clinical relevance of muscle architectural changes and the impact on muscle dysfunction in this population. Understanding the changes that occur in muscle architecture and its impact on long-term impairments in bone sarcoma survivors is important in developing new rehabilitation treatments that optimize functional outcomes.
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Affiliation(s)
- Christa M Nelson
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Victoria Marchese
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kelly Rock
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Robert M Henshaw
- Department of Orthopedic Oncology, MedStar Georgetown Orthopedic Institute, Washington, DC, United States.,Department of Orthopedic Oncology, Children's National Medical Center, Washington, DC, United States
| | - Odessa Addison
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States.,Baltimore VA GRECC, Baltimore, MD, United States
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Wilson PJ, Steadman P, Beckman EM, Connick MJ, Carty CP, Tweedy SM. Fitness, Function, and Exercise Training Responses after Limb Salvage With a Lower Limb Megaprosthesis: A Systematic Review. PM R 2019; 11:533-547. [PMID: 30844129 DOI: 10.1002/pmrj.12045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/17/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe the fitness, function, and exercise training responses of patients following reconstruction of the lower limb with a total femoral (TF), proximal femoral (PF), distal femoral (DF), or proximal tibial (PT) megaprosthesis. TYPE: Systematic review. LITERATURE SURVEY Five research databases were searched systematically for original studies published in English from 2006 to 2017 that reported fitness, functioning, or exercise training responses for one or more of the four types of lower limb megaprosthesis listed above. METHODOLOGY Methodologic quality was assessed using a 22-item modified STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist. SYNTHESIS Of the 5342 articles retrieved, 28 met the inclusion criteria. Thirteen studies reported fitness outcomes, primarily in PT, with none in TF. Impaired knee extensor strength of the affected limb was reported following limb salvage with PF, DF, and PT megaprosthetics. Impaired flexibility was reported following limb salvage with DF and PT megaprosthetics. Functional outcomes were described in all studies and were most commonly reported using the Musculoskeletal Tumor Society (MSTS) system score. Results indicated no clear difference in functional outcomes between megaprosthesis locations. No studies evaluated exercise training responses. CONCLUSIONS This review identified impairments of lower limb strength and flexibility following limb salvage with a lower limb megaprosthesis. Similarity in functional outcomes for all four reported megaprosthetic locations may indicate a lack of sensitivity in outcome measures, including the absence of items assessing higher-level functioning. Exercise interventions that aim to improve fitness and function in this population have not been evaluated but are required given increasing 5-year survival rates. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Paula J Wilson
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Australia
| | - Peter Steadman
- The University of Queensland, School of Medicine, Brisbane, Australia
| | - Emma M Beckman
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Australia
| | - Mark J Connick
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Australia
| | - Christopher P Carty
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, Centre for Children's Health Research, South Brisbane, QLD, Australia
| | - Sean M Tweedy
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Australia.,I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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Morri M, Raffa D, Vigna D, Barbieri M, Mariani E, Donati DM. Which factors are associated with the functional recovery in patients undergoing endoprosthetic knee reconstruction following bone tumour resection? - A observational study. Arch Physiother 2018; 8:11. [PMID: 30619621 PMCID: PMC6311015 DOI: 10.1186/s40945-018-0052-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 12/19/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The aim of the present study was to explore whether control of balance and other factors were associated with functional recovery and walking performance in the short term in a group of patients receiving modular knee endoprosthetic reconstruction following bone tumour resection in order to provide effective suggestions for a new rehabilitation protocol. METHODS A cross-sectional study was carried out in the chemotherapy ward of an Italian hospital specialized in bone cancer. All patients consecutively treated using a modular knee endoprosthetic between January 2013 and February 2014 were included in the study. One year after surgery, various measuring instruments were used to assess the functional outcome achieved: Musculoskeletal Tumor Society rating scale, Toronto Extremity Salvage Score and specific motor tests of gait, such as gait speed and resistance. Data concerning the variables involved are as follows: bone resection, knee joint range of motion, quadriceps muscle strength and posture control. Statistical tests included correlation analysis (Pearson and Spearman correlation). RESULTS Balance control was significantly correlated to all the gait tests performed. Age, duration of chemotherapy and strength of the knee extensor muscles also showed a correlation. Conversely, joint range of motion and resection percentage did not show a significant correlation. CONCLUSIONS Rehabilitation in patients undergoing knee joint reconstruction due to cancer should include balance control exercises, which involve not only the treated limb but address the entire sensory and motor system. This extends beyond the concept of treatment aimed at improving individual functions such as joint range of motion and muscular strength.
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Affiliation(s)
- Mattia Morri
- IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italia
| | - Debora Raffa
- IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italia
| | - Daniela Vigna
- IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italia
| | - Maria Barbieri
- IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italia
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Morri M, Raffa D, Barbieri M, Ferrari S, Mariani E, Vigna D. Compliance and satisfaction with intensive physiotherapy treatment during chemotherapy in patients with bone tumours and evaluation of related prognostic factors: An observational study. Eur J Cancer Care (Engl) 2018; 27:e12916. [PMID: 30260524 DOI: 10.1111/ecc.12916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 07/25/2018] [Accepted: 08/19/2018] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to evaluate compliance and satisfaction of adult patients to intensive rehabilitation treatment during chemotherapy cycles after surgery for bone-musculoskeletal tumours, as well as to identify possible predictive factors. An observational, prognostic, prospective study was conducted. The study enrolled 27 patients who previously had undergone modular knee prosthesis surgery in the period between October 2014 and October 2015. The outcome was compliance to intensive rehabilitation treatment during hospitalisations in the chemotherapy unit and patient satisfaction 6 months' post-surgery. The variables taken into account were linked to the patient's characteristics, to the oncological pathology and to the chemotherapy treatment administered. Patients' compliance was 100% (range, 61-100). The presence of surgery complications (29.6%) produced 5% loss in compliance to treatment; likewise, chemotherapy treatment with prevalent use of ifosfamide reduced compliance to rehabilitation by 6%. The mean patient satisfaction score was 7.9 in the Likert scale from 0 to 10. Intensive physiotherapy starting during chemotherapy administration is a feasible treatment for bone tumour patients that have shown to be able to positively adhere to it. Rehabilitation treatments, within chemotherapy wards, should therefore be promoted according to satisfaction level as reported by patient.
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Affiliation(s)
- Mattia Morri
- Servizio di Assistenza infermieristica, tecnica e della riabilitazione, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Debora Raffa
- Servizio di Assistenza infermieristica, tecnica e della riabilitazione, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Barbieri
- Servizio di Assistenza infermieristica, tecnica e della riabilitazione, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Ferrari
- Reparto di Chemioterapia, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elisabetta Mariani
- Servizio di Medicina Fisica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Daniela Vigna
- Servizio di Assistenza infermieristica, tecnica e della riabilitazione, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Furtado S, Errington L, Godfrey A, Rochester L, Gerrand C. Objective clinical measurement of physical functioning after treatment for lower extremity sarcoma – A systematic review. Eur J Surg Oncol 2017; 43:968-993. [DOI: 10.1016/j.ejso.2016.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 09/27/2016] [Accepted: 10/03/2016] [Indexed: 12/24/2022] Open
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O’Mara K. A Multidisciplinary Approach to Physical Therapy for Patients with Sarcomas. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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17
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O'mara K, Miale S. Establishing Guidelines for Safe and Effective Treatment of Pediatric Sarcoma Survivors: A Mission of the Pediatric Oncology Special Interest Group. Rehabilitation Oncology 2016; 34:117-119. [DOI: 10.1097/01.reo.0000000000000028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Schache MB, McClelland JA, Webster KE. Lower limb strength following total knee arthroplasty: a systematic review. Knee 2014; 21:12-20. [PMID: 24035477 DOI: 10.1016/j.knee.2013.08.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/05/2013] [Accepted: 08/05/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is commonly performed for end-stage knee osteoarthritis to relieve pain and improve quality of life. Understanding specific muscle weakness following TKA is required in order to develop targeted rehabilitation programmes for TKA patients. The aim of this systematic review was to determine whether TKA patients have reduced strength in lower limb muscle groups compared to controls. METHODS A search of common scientific databases was conducted. A modified published checklist was used to assess the risk of bias. A meta-analysis was completed for each lower limb muscle group in three separate post-operative time periods (4-6 months, 1-3 years, and >3 years). The GRADE approach was used to determine the quality of the evidence. RESULTS Fifteen studies met the inclusion criteria for this review. There was low quality evidence for all meta-analyses. The meta-analyses showed that TKA patients had weaker quadriceps than the controls at every post-operative time (pooled effect sizes between -2.81 and -0.53). The meta-analyses of hamstring strength for patients 1-3 years post-operatively also showed patient weakness (pooled effect size=-1.87) and no significant difference at >3 years post-operatively (pooled effect size=-0.20). CONCLUSION There was low quality evidence of quadriceps and hamstring weakness following TKA. Further research is required to determine if other lower limb muscles also display similar muscle weakness. Strategies that specifically target strengthening of these muscle groups may need to be incorporated in rehabilitation to improve outcomes from TKA. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Margaret B Schache
- Department of Physiotherapy, School of Allied Health, La Trobe University, Melbourne, Australia; Donvale Rehabilitation Hospital, Ramsay Health Care, Melbourne, Australia.
| | - Jodie A McClelland
- Department of Physiotherapy, School of Allied Health, La Trobe University, Melbourne, Australia; Lower Extremity and Gait Studies Program, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Kate E Webster
- Lower Extremity and Gait Studies Program, School of Allied Health, La Trobe University, Melbourne, Australia
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Marina N, Hudson MM, Jones KE, Mulrooney DA, Avedian R, Donaldson SS, Popat R, West DW, Fisher P, Leisenring W, Stovall M, Robison LL, Ness KK. Changes in health status among aging survivors of pediatric upper and lower extremity sarcoma: a report from the childhood cancer survivor study. Arch Phys Med Rehabil 2013; 94:1062-73. [PMID: 23380347 DOI: 10.1016/j.apmr.2013.01.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/18/2012] [Accepted: 01/02/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate health status and participation restrictions in survivors of childhood extremity sarcomas. DESIGN Members of the Childhood Cancer Survivor Study cohort with extremity sarcomas who completed questionnaires in 1995, 2003, or 2007 were included. SETTING Cohort study of survivors of extremity sarcomas. PARTICIPANTS Childhood extremity sarcoma survivors (N=1094; median age at diagnosis, 13y (range, 0-20y); current age, 33y (range, 10-53y); 49% male; 87.5% white; 75% had lower extremity tumors) who received their diagnosis and treatment between 1970 and 1986. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Prevalence rates for poor health status in 6 domains and 5 suboptimal social participation categories were compared by tumor location and treatment exposure with generalized estimating equations adjusted for demographic/personal factors and time/age. RESULTS In adjusted models, when compared with upper extremity survivors, lower extremity survivors had an increased risk of activity limitations but a lower risk of not completing college. Compared with those who did not have surgery, those with limb-sparing (LS) and upper extremity amputations (UEAs) were 1.6 times more likely to report functional impairment, while those with an above-the-knee amputation (AKA) were 1.9 times more likely to report functional impairment. Survivors treated with LS were 1.5 times more likely to report activity limitations. Survivors undergoing LS were more likely to report inactivity, incomes <$20,000, unemployment, and no college degree. Those with UEAs more likely reported inactivity, unmarried status, and no college degree. Those with AKA more likely reported no college degree. Treatment with abdominal irradiation was associated with an increased risk of poor mental health, functional impairment, and activity limitation. CONCLUSIONS Treatment of lower extremity sarcomas is associated with a 50% increased risk for activity limitations; upper extremity survivors are at a 10% higher risk for not completing college. The type of local control influences health status and participation restrictions. Both of these outcomes decline with age.
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Affiliation(s)
- Neyssa Marina
- Department of Pediatrics, Stanford University & Lucile Packard Children's Hospital, Palo Alto, CA, USA.
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Tan PX, Yong BC, Wang J, Huang G, Yin JQ, Zou CY, Xie XB, Tang QL, Shen JN. Analysis of the efficacy and prognosis of limb-salvage surgery for osteosarcoma around the knee. Eur J Surg Oncol 2012; 38:1171-7. [PMID: 22809860 DOI: 10.1016/j.ejso.2012.07.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 05/25/2012] [Accepted: 07/02/2012] [Indexed: 11/29/2022] Open
Abstract
AIM Limb-salvage surgery has become the standard of care for extremity osteosarcoma. In this study, we investigated the survival and functional outcomes of patients with osteosarcoma around the knee who were treated with limb-salvage surgery. METHODS We retrospectively reviewed the clinical data for 120 patients with osteosarcoma around the knee who were treated with limb-salvage surgery between 1998 and 2008. The sample included 75 males and 45 females. The mean age of the patients was 18.9 years. Osteosarcoma was diagnosed in the distal femur in 78 patients and in the proximal tibia in 42 patients. Statistical analyses were conducted to process and record the patient data and analyse the surgery's efficacy, prognosis and survival rates. RESULTS All patients were followed for 6-144 months (mean of 56.8 months). The overall 5-year survival rate was 61.8%. Lung metastasis developed in 31 patients. Local recurrence developed in 9 patients. The average Musculoskeletal Tumor Society Score (MSTS) was 25.5 points on a 30-point scale. Sixteen patients underwent prosthesis revision and twelve patients underwent amputation. The overall survivorship of the prosthesis based on Kaplan-Meier estimates was 77% at five years and 71% at ten years. There was a higher incidence of extensor lag for the patients with osteosarcoma in the proximal tibia than for those with osteosarcoma in the distal femur (P < 0.01). CONCLUSIONS Treating osteosarcoma around the knee with limb-salvage surgery can preserve most of the knee's functionality. Attention must be paid to prevent the relatively high incidence of postoperative complications.
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Affiliation(s)
- P X Tan
- Musculoskeletal Tumor Center, Department of Orthopaedic Surgery, First Affiliated Hospital of Sun Yat-Sen University, 14th floor, # 58, Zhongshan 2nd Road, Guangzhou 510080, PR China
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Einsiedel T, Schmelz A, Maghed AE, Kinzl L. Rotationplasty as a limb salvage procedure for infected expandable prosthesis after resection of osteosarcoma: . Current Orthopaedic Practice 2010; 21:635-40. [DOI: 10.1097/bco.0b013e3181f365e4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chang CH, Yang RS, Chen KH, Liu TK, Chen WC, Ho YC, Hou SM. Muscle torque in total knee arthroplasty: comparison of subvastus and midvastus approaches. Knee Surg Sports Traumatol Arthrosc 2010; 18:934-8. [PMID: 20148326 DOI: 10.1007/s00167-010-1066-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 01/12/2010] [Indexed: 01/17/2023]
Abstract
The subvastus and midvastus approaches are two of the most commonly performed quadriceps preserving approaches for total knee arthroplasty (TKA), which can hasten functional recovery and rehabilitation. However, there has not been sufficient investigation with respect to a quantitative comparison between the two approaches in terms of muscle strength. To compare outcomes with respect to muscle strength between these two approaches, quadriceps and hamstring muscle torques of 20 patients who underwent primary TKA with the subvastus (SV) approach and 10 patients who received the midvastus (MV) approach were measured after surgery. The median age of patients in the SV group (68 years, range 53-77 years) was significantly different that the median age of patients in the MV group (61 years, range 50-73 years) (P = 0.0141). There was no significant difference in patient weight, height, or postoperative duration before muscle testing between the SV and MV groups. There were no significant differences in peak muscle torque or hamstring/quadriceps (H/Q) ratio between the groups. We thus conclude peak muscle torque and H/Q ratios were not statistically different with the SV or MV approach, therefore functional outcome is comparable.
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Abstract
PURPOSE OF REVIEW Osteosarcoma and Ewing's sarcoma are the two most common primary malignant bone tumors in children and account for approximately 6% of all childhood malignancies. Treatment methods have seen significant advancements, particularly in regard to chemotherapy and limb-sparing surgery. These advancements have led to increased survival rate. With many long-term survivors, it is important to evaluate long-term patient outcomes following treatment, including function and health-related quality of life. We will review the current trends in treatment of these diseases, different reconstructive options available, and the methods and results for evaluating the long-term results. RECENT FINDINGS There have been many improvements in the medical treatment of these tumors leading to increasing long-term survival. There have also been improvements in reconstructive techniques for the maintenance of functional extremities in these patients. Newer evaluation methods for both functional outcome and health-related quality of life measures that are more specific to children and adolescents are being developed and in use. SUMMARY This report will provide an overview of the current treatment options and long-term complications in primary malignant bone tumors for the pediatrician caring for a child with these problems.
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Punzalan M, Hyden G. The role of physical therapy and occupational therapy in the rehabilitation of pediatric and adolescent patients with osteosarcoma. Cancer Treat Res 2009; 152:367-84. [PMID: 20213402 DOI: 10.1007/978-1-4419-0284-9_20] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The approach to rehabilitation of patients with osteosarcoma has evolved with the many advances in the medical treatment and surgical management of this pediatric and adolescent cancer. In the past, amputation (often radical amputation) was the standard method for treating patients with extremity sarcomas, and rehabilitation was geared toward providing either functional training for patients who had not had limb replacement or prosthetic training for those who had received prostheses. Currently, limb-sparing procedures combined with adjuvant chemotherapy (and occasionally radiotherapy) are used to treat most patients with this disease. In addition, physical-therapy and occupational-therapy interventions are now tailored to address the multiple physical and psychosocial difficulties these patients will face for the remainder of their lives. Integral parts of the interdisciplinary team, practitioners of these disciplines, provide services that enable patients to achieve their highest functional status to permit them to return to their role in society and hence enjoy dignity and improved quality of life.
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Marchese VG, Spearing E, Callaway L, Rai SN, Zhang L, Hinds PS, Carlson CA, Neel MD, Rao BN, Ginsberg J. Relationships among range of motion, functional mobility, and quality of life in children and adolescents after limb-sparing surgery for lower-extremity sarcoma. Pediatr Phys Ther 2006; 18:238-44. [PMID: 17108796 DOI: 10.1097/01.pep.0000232620.42407.9f] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The study was designed to examine relationships between range of motion (ROM), functional mobility, and quality of life (QL) in patients with lower-extremity sarcoma (LES) after limb-sparing surgery METHODS Sixty-eight patients with LES (age, 10-26 years) participated. The patients performed hip flexion, hip extension, knee flexion, and knee extension, Timed Up and Down Stairs (TUDS), Timed Up and Go (TUG), nine-minute run-walk (9-min), and completed the QL measure, Short-Form-36 version two (SF-36v2). RESULTS Significant correlations (p < 0.01) were found between hip extension and SF-36v2 physical component scale (PCS; r = 0.33), TUDS (r = -0.32), TUG (r = -0.33); hip flexion and TUDS (r = -0.31), TUG (r = -0.39), 9-min (r = 0.44); knee flexion and TUDS (r = -0.52), TUG (r = -0.40), 9-min (r = 0.37); SF-36v2 PCS and TUDS (r = -0.56), TUG (r = -0.51), 9-min (r = 0.60). CONCLUSION ROM correlates with functional mobility and QL in patients with LES after limb-sparing surgery. ROM exercises are important component of a physical therapy program for children and adolescents with LES.
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Affiliation(s)
- Victoria G Marchese
- Department of Epidemiology and Cancer Control, St. Jude's Children's Research Hospital, Memphis, Tennessee 38105-2794, USA.
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