Postoperative function recovery in patients with endoprosthetic knee replacement for bone tumour: an observational study

Mattia Morri, Cristiana Forni, Riccardo Ruisi, Tiziana Giamboi, Fabrizio Giacomella, Davide Maria Donati, Maria Grazia Benedetti, Mattia Morri, Cristiana Forni, Riccardo Ruisi, Tiziana Giamboi, Fabrizio Giacomella, Davide Maria Donati, Maria Grazia Benedetti

Abstract

Background: The objective of this study is to describe the rehabilitative pathway of patients undergoing endoprosthetic knee replacement surgery, build reference values ​​of the functional results achieved, and identify possible prognostic factors.

Methods: Prospective observational study. All patients undergoing resection and knee replacement surgery using a modular prosthesis following bone tumor resection were consecutively recruited over the last 2 years. The patients were followed for a period of 1 year, the result values ​​were collected at 3, 6 and 12 months.

Results: In total, 30 patients were enrolled. The median age was 19 years with 33% of patients being female. Median values recorded for knee flexion, quadriceps strength, Toronto Extremity Salvage Score, Time Up and Go and Six Minutes Walking Test showed an improvement of 16, 25, 18, 48 and 38% from 3 to 12 months, respectively. The level and width of the resection were correlated with the mobility of the knee and the strength of the quadriceps.

Conclusion: Patients undergoing knee replacement for bone tumors were able to achieve satisfactory functional outcomes from the first postoperative year. A specific assessment of outcomes can be conducted to facilitate the management of patient expectations. A very wide resection and interventions of the proximal tibia are risk factors for a poorer functional outcome.

Keywords: Bone tumors; Patient outcome assessment; Rehabilitation.

Conflict of interest statement

Ethics approval and consent to participate

All patients provided written informed consent before participation and the study protocol received formal approval from the Ethics Committee of Instituto Ortopedico Rizzoli (n. 0032914).

Competing interests

The authors declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Exercises for patients with endoprosthetic knee replacement
Fig. 2
Fig. 2
Enrolment process
Fig. 3
Fig. 3
Description of patient recovery

References

    1. AIRTUM Working Group. Busco S, Buzzoni C, Mallone S, et al. Italian cancer figures--Report 2015: The burden of rare cancers in Italy. Epidemiol Prev. 2016;40(1 Suppl 2):1–120.
    1. Stiller CA, Bielack SS, Jundt G, Steliarova-Foucher E. Bone tumours in European children and adolescents, 1978-1997. Report from the Automated Childhood Cancer Information System project. Eur J Cancer. 2006;42:2124e35.
    1. Picci Piero, Manfrini Marco, Fabbri Nicola, Gambarotti Marco, Vanel Daniel., editors. Atlas of Musculoskeletal Tumors and Tumorlike Lesions. Cham: Springer International Publishing; 2014.
    1. Asavamongkolkul A, Waikakul S, Phimolsarnti R, Kiatisevi P, Wangsaturaka P. Endoprosthetic reconstruction for malignant bone and soft-tissue tumors. J Med Assoc Thail. 2007;90(4):706–17.
    1. Gosheger G, Gebert C, Ahrens H, Streitbuerger A, Winkelmann W, Hardes J. Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res. 2006;450:164–71. doi: 10.1097/01.blo.0000223978.36831.39.
    1. Qadir I, Umer M, Baloch N. Functional outcome of limb salvage surgery with mega-endoprosthetic reconstruction for bone tumors. Arch Orthop Trauma Surg. 2012;132(9):1227–32. doi: 10.1007/s00402-012-1542-3.
    1. Ginsberg JP, Rai SN, Carlson CA, Meadows AT, Hinds PS, Spearing EM, Zhang L, Callaway L, Neel MD, Rao BN, Marchese VG. A comparative analysis of functional outcomes in adolescents and young adults with lower-extremity bone sarcoma. Pediatr Blood Cancer. 2007;49(7):964–9. doi: 10.1002/pbc.21018.
    1. Bekkering WP, VlietVlieland TP, Koopman HM, et al. A prospective study on quality of life and functional outcome in children and adolescents after malignant bone tumor surgery. Pediatr Blood Cancer. 2012;58(6):978–85. doi: 10.1002/pbc.23328.
    1. Bekkering WP, Vliet Vlieland TP, Koopman HM, Schaap GR, Bart Schreuder HW, Beishuizen A, Jutte PC, Hoogerbrugge PM, Anninga JK, Nelissen RG, Taminiau AH. Functional ability and physical activity in children and young adults after limb-salvage or ablative surgery for lower extremity bone tumors. J Surg Oncol. 2011;103(3):276–82. doi: 10.1002/jso.21828.
    1. Carty CP, Dickinson IC, Watts MC, Crawford RW, Steadman P. Impairment and disability following limb salvage procedures for bone sarcoma. Knee. 2009;16(5):405–8. doi: 10.1016/j.knee.2009.02.006.
    1. Henderson ER, Pepper AM, Marulanda G, Binitie OT, Cheong D, Letson GD. Outcome of lower-limb preservation with an expandable endoprosthesis after bone tumor resection in children. J Bone Joint Surg Am. 2012;94(6):537–47. doi: 10.2106/JBJS.I.01575.
    1. Yalniz E, Ciftdemir M, Memişoğlu S. Functional results of patients treated with modular prosthetic replacement for bone tumors of the extremities. Acta Orthop Traumatol Turc. 2008;42(4):238–245. doi: 10.3944/AOTT.2008.238.
    1. de Visser E, Deckers JA, Veth RP, et al. Deterioration of balance control after limb-saving surgery. Am J Phys Med Rehabil. 2001;80(5):358–65. doi: 10.1097/00002060-200105000-00007.
    1. Shehadeh A, El Dahleh M, et al. Standardization of rehabilitation after limb salvage surgery for sarcomas improves patients' outcome. Hematol Oncol Stem Cell Ther. 2013;6(3–4):105–11. doi: 10.1016/j.hemonc.2013.09.001.
    1. Brosseau L, Tousignant M, Budd J, Chartier N, Duciaume L, Plamondon S, O'Sullivan JP, O'Donoghue S, Balmer S. Intratester and intertester reliability and criterion validity of the parallelogram and universal goniometers for active knee flexion in healthy subjects. Physiother Res Int. 1997;2(3):150–66. doi: 10.1002/pri.97.
    1. Medical Research Council . Aids to the investigation of peripheral nerve injuries. 2. London: Her Majesty’s Stationery Office; 1943.
    1. Davis AM, Wright JG, Williams JI, et al. Development of a measure of physical function for patients with bone and soft tissue sarcoma. Qual Life Res. 1996;5:508–16. doi: 10.1007/BF00540024.
    1. Podsiadlo D, Richardson S. The timed “up and go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–8. doi: 10.1111/j.1532-5415.1991.tb01616.x.
    1. Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed) 1982;284(6329):1607–8. doi: 10.1136/bmj.284.6329.1607.
    1. Ferrari S, Ruggieri P, Cefalo G, et al. Neoadjuvant chemotherapy with methotrexate, cisplatin, and doxorubicin with or without ifosfamide in nonmetastatic osteosarcoma of the extremity: an Italian sarcoma group trial ISG/OS-1. J Clin Oncol. 2012;30(17):2112–8. doi: 10.1200/JCO.2011.38.4420.
    1. Benedetti MG, Zati A, Mariani E, Ruggeri P. Neoplasie primitive dell’apparato muscolo scheletrico: LA RIABILITAZIONE. 2016.
    1. Fung V, Ho A, Shaffer J, Chung E, Gomez M. Use of Nintendo Wii fit™ in the rehabilitation of outpatients following total knee replacement: a preliminary randomised controlled trial. Physiotherapy. 2012;98(3):183–8. doi: 10.1016/j.physio.2012.04.001.
    1. Benedetti MG, ErfeDelayon S, Colangeli M, et al. Rehabilitation needs in oncological patients: the on-rehab project results on patients operated for musculoskeletal tumors. Eur J Phys Rehabil Med. 2017;53(1):81–90.
    1. 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. doi: 10.1007/978-1-4419-0284-9_20.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit