Function and Upright Time Following Limb Salvage, Amputation, and Rotationplasty for Pediatric Sarcoma of Bone

Abstract

We wished to determine the relative physical and psychosocial merits of limb-sparing reconstruction, above-knee amputation, and rotationplasty in survivors of childhood and adolescent lower extremity bone sarcoma. In comparing minimum 5-year disease-free survivors, we found that outcome was somewhat dependent on the measuring tool administered. A superior score of statistical significance on the system of evaluation of the Musculoskeletal Tumour Society and a trend toward higher Toronto Extremity Salvage Scores were found among patients with a limb-sparing reconstruction compared with those with an above-knee amputation. Short-Form 36 results and the amount of time spent in the upright position (uptime), as assessed with a remote activity monitor, were similar between these groups. Uptime was highest in patients who had undergone rotationplasty, although statistical assessment of this group was not feasible. Psychosocial outcome was similar between all groups. This information may be useful in discussing reconstruction with patients and their families.

Does Limb-salvage Surgery Offer Patients Better Quality of Life and Functional Capacity than Amputation?

“…Among our original cohort only 39% of the potentially eligible patients 15 years or older were available for 1-year followup. Although this represents a limitation with a high risk of selection bias, it is generally similar to that of related retrospective series [15,28]. Second, to allow patients to reach a functional plateau, a minimum followup of 1 year was set.…”

“…This resulted in 527 English-language articles published from 1990 to present, from which 11 articles were identified that compared functional status of limb salvage with amputation (Table 3). Only one of 11 publications observed a difference in quality-of-life scores between the two groups [15]. Three publications included an objective, quantitative functional measure [4,10,15].…”

“…subjective questionnaire data as assessed with the Musculoskeletal Tumor Society (MSTS) score [2,15,16,26,28,34] and objective measurements of functional capacity [4,10]. Given the limited information, particularly regarding objective functional measurements, we thought it important to confirm these observations.…”

What are Estimated Reimbursements for Lower Extremity Prostheses Capable of Surgical and Nonsurgical Lengthening?

“…Endoprosthesis alternatives must be considered. Amputation and rotationplasty are alternatives to limb-preservation surgery [4,12,22,30]. These surgeries require the patient to use an external prosthesis for ambulation.…”

A New Incision Technique to Reduce Tibiofemoral Mismatch in Rotationplasty

“…Today, rotationplasty is one option for surgical management of musculoskeletal tumors, particularly in children [2,3,8,18] or as a salvage option after failed reconstruction [4,5,13]. Overall function reportedly is excellent [4,10,15]. There have been no problems with wound healing.…”