Psychosocial and functional outcomes in long‐term survivors of osteosarcoma: A comparison of limb‐salvage surgery and amputation

Abstract

BackgroundTraditionally, physicians have believed that limb‐salvage surgery has functional and cosmetic advantages over amputation, yet the literature is equivocal. Therefore, we sought to compare the psychosocial and functional outcomes in osteosarcoma survivors after limb‐salvage surgery and amputation. We hypothesized there to be neither psychosocial nor functional outcome differences between groups.ProcedureParticipants received treatment of extremity osteosarcoma, had received their cancer diagnosis at least 2 years prior, and were at least 16 years old. A comprehensive set of validated psychosocial and functional measures was used to assess outcome.ResultsFifty‐seven patients participated in this study (33 who underwent limb‐salvage surgery and 24 who underwent amputation). Participants had gone 12–24 years since diagnosis and were 16–52 years old at study participation. We used multiple linear regression models to examine differences in quality of life, body image, self‐esteem, and social support between the two groups and found no differences. Lower limb function was a significant predictor of quality of life (P < 0.001), whereas surgery type did not impact this relationship. Body image was rated significantly worse by those who underwent late amputation, amputation after failed limb salvage, than by those who did not.ConclusionsParticipants with more functional lower limbs had better quality of life than did those with less functional lower limbs regardless of whether they underwent amputation or limb‐salvage surgery. Pediatr Blood Cancer 2010;54:990–999 © 2010 Wiley‐Liss, Inc.

Extensor Function After Medial Gastrocnemius Flap Reconstruction of the Proximal Tibia

“…In line with previous studies, the use of tumor megaendoprostheses and medial gastrocnemius flaps for reconstruction of the proximal tibia and extensor mechanism provides good functional results as assessed by the MSTS score [16,27,34,38]. In a study by Tan at al.…”

“…Limb amputation, Borggreve or Van Nes rotationplasty, and arthrodesis have fallen out of favor as primary options, although these procedures still belong to the armamentarium of the orthopaedic oncologist for selected indications [23,33,34]. Limb salvage techniques involving wide en bloc resection of the tumor represent the mainstay of treatment, being associated with an increased quality of life [16,34].…”

“…Limb amputation, Borggreve or Van Nes rotationplasty, and arthrodesis have fallen out of favor as primary options, although these procedures still belong to the armamentarium of the orthopaedic oncologist for selected indications [23,33,34]. Limb salvage techniques involving wide en bloc resection of the tumor represent the mainstay of treatment, being associated with an increased quality of life [16,34]. The most popular reconstruction methods reported for the proximal tibia include osteoarticular allografts, allograft-prosthetic composite reconstructions, preserving the anatomic position of the tibial tubercle, and tumor mega-endoprostheses mostly with a gastrocnemius flap for coverage [1, 3-5, 9, 11, 12, 14, 18-20, 23, 24, 30, 34, 35, 37-41].…”

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

“…Studies attempting to compare overall quality of life between the two treatment modalities have tended to show no differences [2,23,25,30,34]. Psychological acceptance of LSS and amputation is reportedly similar [21,27,28,32]. Several studies, however, provide evidence for superior function in patients who have undergone LSS; this includes Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.…”

Limb Salvage Surgery for Bone Tumors around the Knee: The Oncological and Functional Outcome—King Hussein Medical Center Experience

“…In the knee, the distal femur is the most common site, followed in descending order by proximal tibia [1][2][3][4][5]. The treatment of malignant or invasive benign bone tumors of the knee is a challenge to orthopedic oncologist surgeon.…”