Gait, Function, and Strength Following Lower Limb Salvage Surgery for a Primary Malignant Bone Tumor: A Systematic Review

Abstract

Background: Primary malignant bone tumors are a rare form of cancer, treated with limb salvage surgery (LSS), which includes sacrifices of muscle and bone. Purpose: To systematically appraise outcomes of gait, physical function (including dynamic balance, transfers, sit-to-stand, and stair climbing) and muscle performance related to the trunk and lower limb in current literature for individuals who have undergone LSS due to a primary bone tumor. Data Sources: Medline, Cochrane, and PEDro databases were searched from inception to June 2020. Study Selection: Following PRISMA guidelines, articles were screened by 2 reviewers independently (J.N. and C.H.) to determine eligibility based on population of interest (adults who have had LSS) and outcomes (gait, trunk, and lower limb physical function or muscle performance). Discrepancies were resolved with a third reviewer until a mutual consensus was reached (S.H.). Data Extraction: Data on gait, function, and muscle strength were extracted and grouped based on the surgical location (ankle, proximal tibia, distal femur, proximal femur/hip, or pelvic region). Data Synthesis: Data were extracted into tables and grouped first based on participants' surgical site and then based on a domain of outcomes (individual or mean group results for gait measures, strength, balance, use of walking aids, or ability to complete a task such as balance or stairs). Results: One thousand four hundred and forty-five abstracts were screened with 32 studies (354 participants) included in the review. Gait speed was reported in 16 studies and use of walking aids reported in 14 studies; these were the most reported outcomes in the review. Knee extensor strength was reported in 6 studies. Following internal hemipelvectomy surgery, 42% of participants ambulated without a walking aid and gait speed was reported as 0.61 to 1.6 m/s. For those who underwent surgery at the hip, 71% ambulated independently with an average gait speed of 0.94 to 1.20 m/s. Of participants who underwent surgery at the knee, 89% ambulated independently with an average gait speed of 0.36 to 1.32 m/s. Following knee LSS, knee extensor strength of the operated limb varied from 2% to 84% compared with the nonoperated side. Physical function outcome measures that were reported in the studies included the Timed Up and Go (TUG),