1
|
Buldu MT, Sacchetti F, Yasen AT, Furtado S, Parisi V, Gerrand C. Return to sports following lower limb musculoskeletal tumor surgery-A systematic review. Scand J Med Sci Sports 2023. [PMID: 37157882 DOI: 10.1111/sms.14382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/23/2022] [Accepted: 04/15/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Survivors of primary malignant musculoskeletal tumors often face long-term disability. Clinicians at present are unable to provide evidence-based advice about returning to sports, which is important for active patients. PURPOSES Identify patients returning to sports. Describe the sporting activities in which patients participate. Identify the outcome measures used to assess return to sport. Identify barriers preventing return to sports. STUDY DESIGN Systematic review. METHODS A comprehensive search strategy was used to identify relevant studies combining the following concepts: (1) Bone/Soft tissue tumor, (2) Lower limb, (3) Surgical interventions, and (4) Sports. Studies were selected according to eligibility criteria with the consensus of three authors (MTB, FS, and CG). RESULTS Twenty-two studies were selected, published between 1985 and 2020, including 1005 patients. Fifteen of the 22 studies had valid data on return to sports, with 705 participants, of which 412 (58.4%) returned to some form of sport such as swimming and cycling, at a mean follow-up period of 7.6 years. Four studies directly compared limb sparing surgery and amputation; none of these were able to identify a difference in sports participation or ability. CONCLUSION There is insufficient published research to provide guidance for patients with respect to return to sports following musculoskeletal tumors. Future prospective studies are needed to collect better pre- and post-treatment data at multiple time intervals. Validated clinical and patient sports participation outcomes such as type of sports, level, frequency, and validated sports-specific outcome scores should be recorded. In particular, more comparison between limb sparing surgery and amputation would be welcome.
Collapse
Affiliation(s)
| | - Federico Sacchetti
- Ortopedia Oncologica e Ricostruttiva, CTO-Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Adam T Yasen
- Royal National Orthopaedic Hospital, Middlesex, UK
| | | | | | | |
Collapse
|
2
|
Döring K, Hegelmaier AV, Trost C, Krall C, Windhager R, Hobusch GM. Early postoperative gain in activity levels of lower extremity sarcoma survivors positively affects long-term physical activity and performance. Support Care Cancer 2023; 31:193. [PMID: 36856930 PMCID: PMC9977709 DOI: 10.1007/s00520-023-07644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/13/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Little is known about the effect of sports activity levels on health-related quality of life (HRQOL) in long-term survivors of lower-extremity sarcoma. METHODS Eighty-three long-term survivors of bone and soft tissue sarcoma of the lower extremities with a median follow-up of 14 (range: 5-35) years completed the University of California and Los Angeles (UCLA) activity scores before tumor resection, 1 year after surgery and at the latest follow-up, as well as a Short Form 36 (SF-36) health survey at the latest follow-up. Simple linear regression models as well as stepwise variable selection with Akaike information criterion (AIC) were undertaken. RESULTS The preoperative UCLA activity level (median: 9, range: 2-10) dropped to a median of 4 (range: 1-10) 1 year after surgery before increasing to a score of 6 (range: 2-10) 5 years after surgery. The long-term SF-36 physical health component summary score (PCS) was 49 (SD: 9), and the mental health component summary score (MCS) was 54 (SD: 7). A linear model with stepwise variable selection identified a negative correlation of PCS with age at surgery (estimate: -0.2; p = 0.02), UCLA score at the last follow-up (estimate: 1.4; p = 0.02) and UCLA score 1 year after surgery (estimate: 1.0; p = 0.02). CONCLUSION As not only the final activity levels but also the status immediately after surgery affect the PCS, higher early activity levels should be a goal of modern rehabilitation after sarcoma treatment. Further studies are needed to weigh the potential postoperative risks of higher sport activity levels against the benefits described in this study. LEVEL OF EVIDENCE Level 4.
Collapse
Affiliation(s)
- Kevin Döring
- Department of Orthopedics and Trauma Surgery, Comprehensive Cancer Canter Vienna, Medical University of Vienna, Waehringer Straße 18-20, 1090 Vienna, Austria
| | - Anna Vanessa Hegelmaier
- Department of Orthopedics and Trauma Surgery, Comprehensive Cancer Canter Vienna, Medical University of Vienna, Waehringer Straße 18-20, 1090 Vienna, Austria
| | - Carmen Trost
- Department of Orthopedics and Trauma Surgery, Comprehensive Cancer Canter Vienna, Medical University of Vienna, Waehringer Straße 18-20, 1090 Vienna, Austria
| | - Christoph Krall
- Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Comprehensive Cancer Canter Vienna, Medical University of Vienna, Waehringer Straße 18-20, 1090 Vienna, Austria
| | - Gerhard Martin Hobusch
- Department of Orthopedics and Trauma Surgery, Comprehensive Cancer Canter Vienna, Medical University of Vienna, Waehringer Straße 18-20, 1090 Vienna, Austria
| |
Collapse
|
3
|
Pesenti S, Choufani E, Prost S, Guillaume JM, Launay F, Jouve JL. Athletic children: Guidelines and monitoring in pediatric orthopedic surgery. Orthop Traumatol Surg Res 2023; 109:103455. [PMID: 36302446 DOI: 10.1016/j.otsr.2022.103455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/13/2022] [Accepted: 04/07/2022] [Indexed: 12/24/2022]
Abstract
In day-to-day practice pediatric orthopedic surgeons often come up against the question of sport. The aim of the present study was to analyze the relationship between sport and childhood, with 3 questions: (1) What are the benefits of sport for children? (2) How to manage high-level child athletes? And (3) What sports are possible after major orthopedic surgery? Sports provide many benefits for children, and are to be encouraged. Sixty minutes' moderate to intense physical activity per day benefits motor development and bone mineralization and reduces the risk of obesity. On the other hand, excessive sports activity, as encountered in high-level sport, can be harmful for the child's development. The amount of training should not exceed a certain threshold in terms of hours per week according to age. Surgical treatment of sport-related traumatic lesions does not necessarily accelerate return to sport: indications need to be reasonable, despite pressure from the patient's circle. Sports are possible after major orthopedic surgery, although return to sport tends to be delayed and the level is lower than preoperatively.
Collapse
Affiliation(s)
- Sébastien Pesenti
- Orthopédie pédiatrique, hôpital d'enfants de la Timone, Aix Marseille université, 264, rue Saint Pierre, 13005 Marseille, France.
| | - Elie Choufani
- Orthopédie pédiatrique, hôpital d'enfants de la Timone, Aix Marseille université, 264, rue Saint Pierre, 13005 Marseille, France
| | - Solène Prost
- Orthopédie pédiatrique, hôpital d'enfants de la Timone, Aix Marseille université, 264, rue Saint Pierre, 13005 Marseille, France
| | - Jean-Marc Guillaume
- Orthopédie pédiatrique, hôpital d'enfants de la Timone, Aix Marseille université, 264, rue Saint Pierre, 13005 Marseille, France
| | - Franck Launay
- Orthopédie pédiatrique, hôpital d'enfants de la Timone, Aix Marseille université, 264, rue Saint Pierre, 13005 Marseille, France
| | - Jean-Luc Jouve
- Orthopédie pédiatrique, hôpital d'enfants de la Timone, Aix Marseille université, 264, rue Saint Pierre, 13005 Marseille, France
| |
Collapse
|
4
|
Systemic Treatment of Ewing Sarcoma: Current Options and Future Perspectives. FORUM OF CLINICAL ONCOLOGY 2022. [DOI: 10.2478/fco-2021-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Ewing sarcoma (ES) is an uncommon malignant neoplasm, mostly affecting young adults and adolescents. Surgical excision, irradiation, and combinations of multiple chemotherapeutic agents are currently used as a multimodal strategy for the treatment of local and oligometastatic disease. Although ES usually responds to the primary treatment, relapsed and primarily refractory disease remains a difficult therapeutic challenge. The growing understanding of cancer biology and the subsequent development of new therapeutic strategies have been put at the service of research in recurrent and refractory ES, generating a great number of ongoing studies with compounds that could find superior clinical outcomes in the years to come. This review gathers the current available information on the treatment and clinical investigation of ES and aims to be a point of support for future research.
Collapse
|
5
|
Mester B, Guder W, Streitbürger A, Schoepp C, Nottrott M, Podleska L, Dudda M, Hardes J. Return to Sports and Activity in Tumor Orthopaedics. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021. [PMID: 34879419 DOI: 10.1055/a-1676-5266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION As survival rates associated with the multimodal treatment of malignant bone cancer (osteosarcoma and Ewing's sarcoma) are satisfactory, health-related quality of life and the return to activity and sports by the affected patients have attracted increasing attention in recent years. Nowadays, limbs can be salvaged for most patients using modular endoprostheses. Such patients are typically adolescents and young adults who have high activity levels and thereby high demands for multimodal cancer treatment. This study aimed to evaluate the activity levels and sporting proficiencies that can be attained after modular endoprosthetic treatment of bone sarcomas as well as the extent to which physiotherapeutic and sports interventions influence functional outcome and activity levels. METHODS This non-systematic review of the literature focused on the return to activity and sports after modular endoprosthetic treatment of lower extremities bone sarcomas in adolescents and young adults. The electronic database PubMed was screened for relevant publications on this issue. A treatment algorithm for return to activity and sports in tumor orthopaedics is proposed. RESULTS AND DISCUSSION The objective activity level (gait cycles per day and gait intensities) in patients treated for bone sarcomas is reduced in short- and long-term follow-ups compared with healthy controls and patients with other cancers (leukaemia). Although a negative impact is observed in terms of motor performance, it shows improvement over time. Functional assessment at 12 postoperative months is sensible as neoadjuvant chemotherapy is completed by then. In long-term follow-up, patients with bone sarcomas can achieve high sports activity levels, i.e., type of sport, frequency/week and UCLA score, after modular endoprosthetic reconstruction. The maximum level is attained at 5 years postoperatively. Nevertheless, there is a shift from high- and intermediate- to low-impact sports. Only 20% of the patients participate in school sports regularly without limitations. The localisation of bone sarcoma, but not the rate of postoperative complications, influences the postoperative activity level. Individualised sports-related interventions during and after multimodal treatment can improve the short-term activity levels; moreover, "serious games" can improve motor performance and postural control. There is no evidence that intense activity levels leads to early loosening of the endoprosthesis. There is insufficient valid data on activity and sports after modular endoprosthetic treatment of bone sarcomas of the upper extremities. CONCLUSION High preoperative activity levels of young patients with bone sarcomas must be considered in tumour orthopaedics. Limitations on sports activities have a significant negative impact on the quality of life and mental health of such patients. Therefore, tumour orthopaedic treatment has to focus on preserving an improvement in these factors. The overall existing evidence concerning this issue is weak. Additional studies to evaluate the ability to return to specific sports activities are desirable, as well as prospective interventional studies.
Collapse
Affiliation(s)
- Bastian Mester
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Wiebke Guder
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Arne Streitbürger
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Christian Schoepp
- Klinik für Arthroskopische Chirurgie, Sporttraumatologie und Sportmedizin, BG Klinikum Duisburg, Universität Duisburg-Essen, Duisburg, Deutschland
| | - Markus Nottrott
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Lars Podleska
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Marcel Dudda
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Universität Duisburg-Essen, Duisburg, Deutschland.,Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Jendrik Hardes
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| |
Collapse
|
6
|
Nystrom LM. CORR Insights®: Clinically Important Reductions in Physical Function and Quality of Life in Adults with Tumor Prostheses in the Hip and Knee: A Cross-sectional Study. Clin Orthop Relat Res 2021; 479:2320-2322. [PMID: 34156987 PMCID: PMC8445556 DOI: 10.1097/corr.0000000000001879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/08/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Lukas M Nystrom
- Associate Professor, Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
7
|
Lang NW, Kasparek MF, Synak L, Waldstein W, Funovics PT, Windhager R, Hobusch GM. What sports activity levels are achieved in long-term survivors with modular endoprosthetic humerus reconstruction following primary bone sarcoma resection? Wien Klin Wochenschr 2020; 133:14-20. [PMID: 33296025 PMCID: PMC7840635 DOI: 10.1007/s00508-020-01779-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022]
Abstract
Background The aim of the study was to assess (1) sports activity, (2) sports involving the upper extremities, (3) functional outcome and (4) sports-related complications of long-term survivors of primary malignant bone tumors of the proximal humerus. Methods A total of 18 patients with an endoprosthetic reconstruction for primary malignant bone sarcoma of the proximal humerus (8 male, 10 female, mean age 19.9 ± 8.4 years, range 7.8–37.4 years) with an average follow-up of 18.1 ± 7.4 years (range 6.7–29.8 years) were included. The type of sport, frequency, duration of each sport session and the University of California, Los Angeles (UCLA) activity score were assessed before surgery, at 1 year, 3 years and at the latest follow-up. Functional outcome was assessed by the Toronto extremity salvage score (TESS). Results The mean UCLA activity score decreased from 8.0 (±1.3, range 5–9) preoperative to 4.2 (±1.7, range 3–8) at 1‑year follow-up (p < 0.05). After 3 years it increased to 5.1 (±1.75, range 3–8) and further to 7 (±1.8, range 4–9) at the last follow-up. The mean postoperative TESS was 80.8 (±6.4, range 75.7–91.4) at the latest follow-up. Patients who were initially more active without reconstruction including a synthetic mesh were more likely to develop soft tissue complications accompanied by proximal endoprothesis migration. Conclusion Patients with a modular endoprosthetic reconstruction of the humerus following primary bone sarcoma resume participation in sports. Regarding the low incidence of periprosthetic infections, utilization of a synthetic mesh for reconstruction to prevent soft tissue complications in active patients should be considered.
Collapse
Affiliation(s)
- Nikolaus W Lang
- Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria
| | - Maximilian F Kasparek
- Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria
| | - Lukas Synak
- Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria
| | - Wenzel Waldstein
- Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria
| | - Philipp T Funovics
- Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria
| | - Gerhard M Hobusch
- Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
8
|
Hobusch GM, Keusch F, Tsuchiya H, Joyce M, Windhager R. What Opinions Do Tumor Reconstructive Surgeons Have about Sports Activity after Megaprosthetic Replacement in Hip and Knee? Results of the MoReSports Expert Opinion Online Survey. J Clin Med 2020; 9:E3638. [PMID: 33198264 PMCID: PMC7698049 DOI: 10.3390/jcm9113638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022] Open
Abstract
Sports activity has many benefits in cancer survivors. A key one is having sport activity contribute to the well-being of the individual. However, there are no guidelines about the intensity and kind of postoperative mobility workouts after hip or knee megaprosthetic treatment. Opinion research about sports after modular bone and joint replacement may provide an understanding of surgeons' attitudes on sports activity after megaprostheses of the hip and knee joint. A web survey with members of three international professional organizations of orthopedic tumor reconstructive surgeons was conducted between September 2016 and January 2018. Members were invited via personalized emails by the European Musculoskeletal Oncology Society (EMSOS), the International Society of Limb Salvage (ISOLS), and the Musculoskeletal Tumor Society (MSTS). The questionnaire included 26 questions. A total of 149 surgeons started the survey, and 76 finished the entire survey (American Association for Public Opinion Research (AAPOR) second response rate (RR2) EMSOS: 12.3%; ISOLS: 21.9%; MSTS: n/a). More than half of the respondents encourage sarcoma survivors after megaprosthetic treatment to reach an activity level that would allow them to regularly participate in active sporting events of University of California, Los Angeles (UCLA) activity level 7 and higher. Orthopedic tumor reconstructive surgeons do fear a number of complications (periprosthetic fracture, allograft failure/fracture, loosening, prosthetic or bearing failure, and early polyethylene wear) due to sports activity after modular bone-joint replacement, but they actually witness fewer complications than they conceptually anticipated. According to the surgeons' opinions, between four to seven types of sports after surgery could reasonably be recommended depending on the type of hip or knee procedures. This survey provides insights into opinions on what could be recommended, what could be allowed if surgeons and their patients agree on the potential negative outcome, and which sports should definitely not be allowed after hip and knee megaprostheses.
Collapse
Affiliation(s)
- Gerhard M. Hobusch
- Department of Orthopaedic and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Florian Keusch
- Department of Sociology, University of Mannheim, 68131 Mannheim, Germany;
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa 920-1192, Ishikawa, Japan;
| | - Michael Joyce
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44106, USA;
| | - Reinhard Windhager
- Department of Orthopaedic and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria;
| |
Collapse
|
9
|
Hobusch GM, Cernakova M, Puchner SE, Kolb A, Panotopoulos J, Windhager R. Sports activity after soft tissue sarcoma of the lower extremity. Disabil Rehabil 2019; 42:14-19. [DOI: 10.1080/09638288.2018.1520929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Gerhard M. Hobusch
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Miroslava Cernakova
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Stephan E. Puchner
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Alexander Kolb
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Joannis Panotopoulos
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| |
Collapse
|
10
|
Brunet J, Wurz A, Shallwani SM. A scoping review of studies exploring physical activity among adolescents and young adults diagnosed with cancer. Psychooncology 2018; 27:1875-1888. [PMID: 29719077 DOI: 10.1002/pon.4743] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Physical activity can improve health, functional capacity, and quality of life among children and adults diagnosed with cancer. Physical activity may also offer important benefits to adolescents and young adults diagnosed with cancer (AYAs). We conducted a scoping review to: determine the extent, range, and nature of published studies on physical activity among AYAs; identify knowledge gaps; and provide directions for future research. METHODS We searched 4 electronic databases for published studies. Two authors independently scanned the titles, abstracts, and full-texts against inclusion criteria: original research with humans, published in an English-language peer-reviewed journal, ≥50% of participants were diagnosed with cancer between the ages of 15 and 39 years, and included at least 1 measure of physical activity behavior. Data were extracted from studies meeting these criteria and subsequently summarized narratively. RESULTS Our search yielded 4729 articles; 32 met inclusion criteria. These included 18 cross-sectional and 4 longitudinal studies that explored descriptive (ie, sociodemographic or medical), physical, personal/psychological, social, other health behaviors, and/or other factors as antecedents or correlates of physical activity. The remaining 10 were intervention studies that focused on changing physical activity behavior or on testing the effects of physical activity. CONCLUSIONS We can conclude that physical activity is not well researched among AYAs. More high-quality research adopting longitudinal or intervention study designs that incorporate a range of descriptive, physical, personal/psychological, social, and environmental measures are warranted to better inform the development of behavior change interventions as well as to establish the benefits of physical activity for AYAs.
Collapse
Affiliation(s)
- Jennifer Brunet
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,Institut du savoir Montfort, Hôpital Montfort, Ottawa, Ontario, Canada.,Cancer Therapeutic Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Amanda Wurz
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Shirin M Shallwani
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
11
|
What Sport Activity Levels Are Achieved in Patients After Resection and Endoprosthetic Reconstruction for a Proximal Femur Bone Sarcoma? Clin Orthop Relat Res 2017; 475:817-826. [PMID: 27020426 PMCID: PMC5289166 DOI: 10.1007/s11999-016-4790-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Limited information is available about sports activities of survivors after resection and reconstruction of primary malignant bone tumors with megaprostheses. Because patients often ask what activities are possible after treatment, objective knowledge about sports activities is needed to help assess the risks of sports participation and to help guide patients' expectations. QUESTIONS/PURPOSES The aims of this study were to evaluate (1) what proportion of patients with proximal-femoral megaprostheses placed as part of tumor reconstructions can perform sports; (2) what activity levels they achieved; and (3) whether sports activity levels are associated with an increased likelihood of revision. METHODS This retrospective study considered all 27 living patients in our institutional tumor registry with enduring proximal-femoral reconstructions performed more than 5 years ago who were between the ages of 11 and 49 years at the time of the reconstruction; seven were lost to followup and one was excluded because of paraplegia as a result of a car accident and another because of senile dementia; another two were excluded from statistics because of growing prostheses and skeletal immaturity at the time of followup, leaving 16 (11 male, five female) for analysis. Their mean age was 26 ± 12 years (range, 11-49 years) at surgery, and the mean followup was 18 ± 7 years (range, 5-27 years). Types of sports, frequency per week, duration of each sports session as well as the UCLA and modified Weighted Activity Score were assessed retrospectively by an independent assessor a median of 18 years (range, 5.3-27 years) after surgery. RESULTS Patients recalled that preoperatively 14 were practicing sports 5 (± 4) hours/week. At followup, 11 of the patients were practicing one or more sports activities 2 (± 3) hours/week on a regular basis. The preoperative UCLA and modified Weighted Activity Score levels of 9 and 6 fell to levels of 6 (p = 0.005) and 3 (p = 0.025), respectively, at followup. With the numbers of patients available for study, we could not determine that prosthetic failures were associated with sport activity levels. CONCLUSIONS Patients who survive primary malignant bone tumors in the proximal femur reconstructed by megaprostheses are able to perform some sports activities. The estimates of activity levels made in this study probably are best-case estimates, given that some patients were lost to followup; patients unaccounted for might not be doing as well as those represented here. Also, the degree to which sports participation influences implant durability remains, for the most part, unanswered; studies with more patients and longer followup will be needed to determine to what degree prosthesis survivorship relates to sporting activity levels. Most patients perform low-impact sports and at a lower level than they had preoperatively. Because this is a preliminary study of a select group of patients, further information is necessary to weight the benefits of higher sports activity levels against potential risks. If this can be confirmed in a larger number of patients, the information may guide surgeons in their discussion with patients preoperatively and give them some objective assessment of what to expect regarding sports activities. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
|
12
|
San-Julian M, Vazquez-Garcia B. Biological Reconstruction in Bone Sarcomas: Lessons from Three Decades of Experience. Orthop Surg 2017; 8:111-21. [PMID: 27384719 DOI: 10.1111/os.12243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/13/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mikel San-Julian
- Orthopaedic Surgery and Traumatology Unit, Clinica University of Navarra, Pamplona, Spain
| | | |
Collapse
|
13
|
Abstract
Treatment of bone sarcoma requires careful planning and involvement of an experienced multidisciplinary team. Significant advancements in systemic therapy, radiation, and surgery in recent years have contributed to improved functional and survival outcomes for patients with these difficult tumors, and emerging technologies hold promise for further advancement.
Collapse
Affiliation(s)
- Christina J Gutowski
- Department of Orthopedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street, Room 516 College, Philadelphia, PA 19107, USA
| | - Atrayee Basu-Mallick
- Department of Medical Oncology, Sarcoma and Bone Tumor Center at Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, 1025 Walnut Street, Suite 700, Philadelphia, PA 19107
| | - John A Abraham
- Department of Orthopedic Surgery, Rothman Institute at Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107, USA; Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111, USA.
| |
Collapse
|
14
|
Hobusch GM, Tiefenboeck TM, Patsch J, Krall C, Holzer G. Do Patients After Chondrosarcoma Treatment Have Age-appropriate Bone Mineral Density in the Long Term? Clin Orthop Relat Res 2016; 474:1508-15. [PMID: 26883654 PMCID: PMC4868166 DOI: 10.1007/s11999-016-4741-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/26/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND In long-term survivors of osteosarcoma and Ewing sarcoma treated with the addition of radio- and chemotherapy, low bone mineral density (BMD) and fractures have been observed, presumably resulting from these adjuvants. Because patients with chondrosarcoma usually are not treated with conventional adjuvant treatment, observation of low BMD in patients with chondrosarcoma presumably would be the result of other mechanisms. However, BMD in patients with a history of chondrosarcoma has not been well characterized. QUESTIONS/PURPOSES The aim of our study was to address the following questions: (1) Do long-term survivors of chondrosarcoma have normal BMD and, if not, which factors contribute to low BMD? (2) Is there a greater risk of fracture and does the Fracture Risk Assessment Tool (FRAX(®)) score reflect fracture likelihood? METHODS All known patients with a history of chondrosarcoma treated at our institution before 2006 were identified. Of 127 patients believed to be alive at the time of this study, 30 agreed to participate in this study (11 females, 19 males; mean age at surgery, 39 ± 12 years; mean followup, 12 ± 5 years). With the data available, the 30 participants were not different from the 97 nonparticipants in terms of age, sex, BMI, tumor grade, tumor location (axial versus appendicular, lower extremity versus elsewhere), and use of any treatment known to influence osteopenia (chemotherapy, lower extremity surgery). BMD was measured and history of fractures was assessed using a questionnaire. The patients´ BMD measurements in this study were sex- and age-matched with a normative sex- and age-categorized reference population reported by Kudlacek et al. Associations were tested by univariate regressions and ANOVAs of all measures of BMD and eligible oncologic and demographic factors. RESULTS Eighteen of 30 (60%) patients had a pathologic BMD according to the WHO dual-energy x-ray absorptiometry definition, 15 (50%) had osteopenia, and three (10%) had osteoporosis. T-scores in the study cohort were lower than reference values for the femur neck (mean difference, 0.64; 95% CI, 0.27-1.01; p < 0.0015), but not for the spine (mean difference, 0.39; 95% CI, -0.06 to 0.84; p = 0.09). Thirteen patients (45%) reported a history of fractures not distinguishing between low and high impact. The incidence of fractures was 2.8 greater than expected from a comparison with a published microcensus survey of the Austrian population. No effect of the FRAX(®) score on fracture risk could be identified (p = 0.057). CONCLUSIONS Long-term survivors of chondrosarcoma appear to be at greater risk for having low BMD develop than the healthy population. Although these results are preliminary and based on a very small sampling of patients, if they can be confirmed in larger studies, BMD assessment by dual-energy x-ray absorptiometry might be considered as these patients are followed posttreatment by sarcoma care units. The reasons for low BMD still must be elucidated. LEVEL OF EVIDENCE Level IV, prognostic study.
Collapse
Affiliation(s)
- Gerhard M Hobusch
- Department of Orthopaedic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas M Tiefenboeck
- Department of Orthopaedic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Janina Patsch
- Department of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Christoph Krall
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Gerold Holzer
- Department of Orthopaedic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|