The importance of the rehabilitation program following an internal hemipelvectomy and reconstruction with limb salvage – gait analysis and outcomes: a case study

Abstract

Following the intensive 2-year rehabilitation program this patient's gait pattern was similar to a control group with no statistically significant difference in the movement of the left and right knee and ankle joints. Some differences were identified against the control group in respect of the movement of the pelvis and hips, but this is partly to be expected. This case study highlights the functional outcomes that can be achieved following limb salvage surgery with intensive rehabilitation and a high level of motivation from the individual. Implications for rehabilitation Advancements in chemotherapy, imaging and surgical techniques have allowed more patients to be treated with internal hemipelvectomy. The rehabilitation outcomes following an internal hemipelvectomy have not been well identified and there is little gait analysis data. This case study highlights the functional outcomes that can be achieved following limb salvage surgery with intensive rehabilitation and motivation from the individual. Rehabilitation following internal hemipelvectomy should include goal setting, lymphoedema management, physiotherapy and an exercise program.

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

“…Diagnoses included 10 types of bone sarcomas. Three articles described the outcomes of osteosarcoma [26][27][28] and 4 reported chondrosarcomas [29][30][31][32] exclusively. The remaining studies described outcomes in participants with mixed types of sarcomas.…”

“…Use of compensatory movement strategies is also required to understand movement quality or control in gait. Function in those following pelvic surgery and intensive extended rehabilitation programs has been observed 32. One study defined intensive rehabilitation as 13 admissions of 3- to 6-week periods whereby the individual received 1 hour of daily physiotherapy, over the span of 2 years 32…”

“…Function in those following pelvic surgery and intensive extended rehabilitation programs has been observed. 32 One study defined intensive rehabilitation as 13 admissions of 3-to 6-week periods whereby the individual received 1 hour of daily physiotherapy, over the span of 2 years. 32 Slow gait speed for individuals following lower LSS may restrict community access.…”

“…Eight studies observed patients who underwent an internal hemipelvectomy surgery (n = 50), 14,[31][32][33][34][35][36][37] with measures taken between 2 months and 23 years following surgery (Table 2). Walking status was observed in 48 participants, with 42% able to ambulate without a walking aid (n = 20), 23% used 1 crutch or 1 stick (n = 11), 25% used 2 crutches or canes (n = 12), 2% used of a walker (n = 1), and 8% were nonambulant (required a wheelchair [n = 1]; "bedridden" [n = 3]).…”

Computational evaluation of psoas muscle influence on walking function following internal hemipelvectomy with reconstruction

“…Sixth (and probably the biggest limitation), no directly comparable post-surgery walking data were available for validation purposes from either the subject modeled in this study (a healthy volunteer) or previous studies. The closest experimental data are from a case study reported by Wingrave and Jarvis 2018 ( Wingrave and Jarvis, 2018 ), which measured post-surgery walking function of a single patient following internal hemipelvectomy. Unlike in our computational study, the patient in that study was not reconstructed with a custom prosthesis, and no list of resected muscles was included, making comparison with our computational predictions infeasible.…”