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Ng YH, Chai YC, Mazli N, Jaafar NF, Ibrahim S. Outcome of Endoprosthesis used in Limb Salvage Surgery in a Malaysian Orthopaedic Oncology Centre. Malays Orthop J 2024; 18:60-65. [PMID: 38638655 PMCID: PMC11023336 DOI: 10.5704/moj.2403.008] [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: 06/02/2023] [Accepted: 08/14/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction To describe the duration of survival among bone tumour patients with endoprosthesis reconstruction and to determine frequency of implant failure, revision of surgery, and amputation after endoprosthesis reconstruction. Materials and methods A retrospective cross-sectional review of all patients with either primary bone tumour or secondary bone metastases treated with en bloc resection and endoprosthesis reconstruction from January 2008 to December 2020. Results A total of 35 failures were recorded among the 27 (48.2%) patients with endoprostheses. Some of the patients suffered from one to three types of modes of failure on different timelines during the course of the disease. Up to eight patients suffered from more than one type of failure throughout the course of the disease. Out of all modes of failure, local recurrence (type 5 failure) was the most common, accounting for 25.0% of all failure cases. Four patients (7.1%) eventually underwent amputation, which were either due to infection (2 patients) or disease progression causing local recurrence (2 patients). Conclusion The overall result of endoprosthesis reconstruction performed in our centre was compatible with other centres around the world. Moreover, limb salvage surgery should be performed carefully in a selected patient group to maximise the benefits of surgery.
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Affiliation(s)
- Y H Ng
- Department of Orthopaedic, Hospital Sultan Ismail, Johor Bahru, Malaysia
| | - Y C Chai
- General Psychiatry Division, Hospital Permai Johor Bahru, Johor Bahru, Malaysia
| | - N Mazli
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - N F Jaafar
- Department of Orthopaedic, Hospital Sultan Ismail, Johor Bahru, Malaysia
| | - S Ibrahim
- Department of Orthopaedic, Hospital Sultan Ismail, Johor Bahru, Malaysia
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Filis P, Varvarousis D, Ntritsos G, Dimopoulos D, Filis N, Giannakeas N, Korompilias A, Ploumis A. Prosthetic reconstruction following resection of lower extremity bone neoplasms: A systematic review and meta-analysis. J Bone Oncol 2022; 36:100452. [PMID: 36105628 PMCID: PMC9465097 DOI: 10.1016/j.jbo.2022.100452] [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: 06/20/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/27/2022] Open
Abstract
Prosthetics are the mainstay in surgery after resection of extremity bone tumors. For these patients gait parameters deteriorated compared to healthy individuals. Further refinement of surgical techniques is required. New rehabilitation strategies and follow-up programming are needed.
Prosthetic reconstructive procedures have become the mainstay in contemporary surgical treatment following resection of extremity bone neoplasms. Given that these patients are of young age most of the time, achievement of robust functional outcomes is of paramount importance. The aim of this study is to assess the impact of this procedure on the gait parameters of cancer patients compared to healthy individuals. The Medline, Scopus and Cochrane databases were systematically searched until January 2022 for eligible studies. Gait parameters measured by gait analysis after prosthetic reconstruction were the outcomes of interest. Eight cohort studies were included in our analysis. From these, seven studied prosthetic reconstruction of the knee (distal femur or proximal tibia) and only one exclusively studied prostetic reconstructions of the proximal femur. Compared to healthy individuals a significant decrease was evident in gait velocity (-0.16 m/sec, 95 %CI: −0.23 to −0.09, p-value < 0.001), in stride length (-6.07 %height, 95 %CI: −9,36 to −2.78, p-value < 0.001), in cadence (-3.96 stride/min, 95 %CI: −5.41 to −2.51, p-value < 0.001) and significant increase in cycle time (0.10 s, 95 %CI: 0.03 to 0.17, p-value = 0.005). Prosthetic reconstruction following lower limb tumor resection significantly affects the gait of patients. This knowledge can be utilized for further refinement of surgical techniques, rehabilitation strategies and follow-up programming.
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Affiliation(s)
- Panagiotis Filis
- Department of Medical Oncology, University of Ιoannina, 45110 Ιoannina, Greece.,Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Dimitrios Varvarousis
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, 45110 Ioannina, Greece
| | - Georgios Ntritsos
- Department of Informatics and Telecommunications, University of Ioannina, 47100 Arta, Greece
| | - Dimitrios Dimopoulos
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, 45110 Ioannina, Greece
| | - Nikolaos Filis
- Medical School, University of Ioannina, 45110 Ιoannina, Greece
| | - Nikolaos Giannakeas
- Department of Informatics and Telecommunications, University of Ioannina, 47100 Arta, Greece
| | - Anastasios Korompilias
- Division of Orthopaedic Surgery, Department of Surgery, University of Ioannina Medical School, 45110 Ioannina, Greece
| | - Avraam Ploumis
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, 45110 Ioannina, Greece
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Gao B, Wang MD, Li Y, Huang F. Risk stratification system and web-based nomogram constructed for predicting the overall survival of primary osteosarcoma patients after surgical resection. Front Public Health 2022; 10:949500. [PMID: 35991065 PMCID: PMC9389295 DOI: 10.3389/fpubh.2022.949500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background Previous prediction models of osteosarcoma have not focused on survival in patients undergoing surgery, nor have they distinguished and compared prognostic differences among amputation, radical and local resection. This study aimed to establish and validate the first reliable prognostic nomogram to accurately predict overall survival (OS) after surgical resection in patients with osteosarcoma. On this basis, we constructed a risk stratification system and a web-based nomogram. Methods We enrolled all patients with primary osteosarcoma who underwent surgery between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database. In patients with primary osteosarcoma after surgical resection, univariate and multivariate cox proportional hazards regression analyses were utilized to identify independent prognostic factors and construct a novel nomogram for the 1-, 3-, and 5-year OS. Then the nomogram's predictive performance and clinical utility were evaluated by the concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Result This study recruited 1,396 patients in all, with 837 serving as the training set (60%) and 559 as the validation set (40%). After COX regression analysis, we identified seven independent prognostic factors to develop the nomogram, including age, primary site, histological type, disease stage, AJCC stage, tumor size, and surgical method. The C-index indicated that this nomogram is considerably more accurate than the AJCC stage in predicting OS [Training set (HR: 0.741, 95% CI: 0.726–0.755) vs. (HR: 0.632, 95% CI: 0.619–0.645); Validation set (HR: 0.735, 95% CI: 0.718–0.753) vs. (HR: 0.635, 95% CI: 0.619–0.652)]. Moreover, the area under ROC curves, the calibration curves, and DCA demonstrated that this nomogram was significantly superior to the AJCC stage, with better predictive performance and more net clinical benefits. Conclusion This study highlighted that radical surgery was the first choice for patients with primary osteosarcoma since it provided the best survival prognosis. We have established and validated a novel nomogram that could objectively predict the overall survival of patients with primary osteosarcoma after surgical resection. Furthermore, a risk stratification system and a web-based nomogram could be applied in clinical practice to assist in therapeutic decision-making.
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Affiliation(s)
- Bing Gao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Meng-die Wang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yanan Li
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Fei Huang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Fei Huang
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Jawad MU, Pollock BH, Alvarez E, Carr-Ascher JR, Randall RL, Thorpe SW. Non-Private Health Insurance Predicts Advanced Stage at Presentation and Amputation in Lower Extremity High Grade Bone Sarcoma: A National Cancer Database Study : Amputation Predicts Survival: An Effect Most Pronounced in Pediatric and AYA Age Group. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11494-4. [PMID: 35314919 DOI: 10.1245/s10434-022-11494-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/03/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Advances in diagnostic and treatment modalities for high grade bone sarcomas (HGBS) of lower extremity (LE) have enabled limb salvage resections as a feasible first-line surgical option. However, amputations are still performed. Impact of amputation on survival and predictive factors for amputation and the stage at presentation for HGBS of LE remain unknown. METHODS National Cancer Database was used to extract 5781 cases of high-grade bone sarcoma of the LE from 2004 to 2017. Kaplan-Meier and Cox regression were used to determine the impact of amputation on survival. Chi square test and logistic regression were used to assess the correlation of predictive factors with amputation and stage at presentation. RESULTS Amputation [hazard ratio (HR) 1.516; 95% confidence interval (CI) 1.259-1.826; p < 0.001] and advanced stage (HR 0.248; 95% CI 0.176-0.351; p < 0.001) were independent predictors of poor overall survival. The impact of amputation on survival was most pronounced for pediatric and adolescents and young adults (AYA) age groups (18% decrease in 10-year survival). Amputation was more likely to be performed among those with nonprivate insurance (HR 1.736; 95% CI 1.191-2.531; p = 0.004), a finding that was mirrored for advanced stage at presentation (HR 0.611; 95% CI 0.414-0.902; p = 0.013). DISCUSSION Amputation is an independent predictor of poor outcomes among patients with HGBS of LE. The impact of amputation on survival is the highest for the pediatric and AYA age group. Nonprivate insurance is associated with increased likelihood of amputation and an advanced stage at presentation among patients with high-grade bone sarcoma of the LE. This is the largest study highlighting insurance-related disparities in this cohort.
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Affiliation(s)
- Muhammad Umar Jawad
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Brad H Pollock
- Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Elysia Alvarez
- Department of Pediatrics, University of California, Davis, Davis, CA, USA
| | - Janai R Carr-Ascher
- Department of Internal Medicine, University of California, Davis, Davis, CA, USA
| | - R Lor Randall
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Steven W Thorpe
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA.
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Yao W, Cai Q, Wang J, Zhang P, Wang X, Du X, Niu X. Biological reconstruction in the treatment of extremity sarcoma in femur, tibia, and humerus. Medicine (Baltimore) 2020; 99:e20715. [PMID: 32629645 PMCID: PMC7337607 DOI: 10.1097/md.0000000000020715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
To understand the feasibility, clinical effect, and complications related to biological reconstruction techniques for long limb malignant bone tumors after excision.This retrospective study included eighty patients with malignant bone tumors treated at our hospital between January 2007 and January 2019. After tumor resection, 52 cases of intercalary and 28 cases of osteoarticular bone grafts were used. The implanted bone included devitalized recycling bone, fibular, and allograft.The average follow up period was 42.19 months for 80 patients, among whom 15 (18.75%) died. The 5-year EFS and OS were 58% and 69%, respectively. The average length of the replanted bone was 18.57 cm. The MSTS scores of intercalary and osteoarticular bone grafts were 87.24% and 64.00%, respectively. In 23 cases (44.23%) of metaphyseal and 26 cases (32.5%) of the diaphysis, bone graft union was obtained at the first stage. The factors affecting bone union were the patient's gender, age, devitalization bone methods and whether the implanted bone was completely fixed. Postoperative complications included delayed bone union in 15 patients, fractures in 25 cases, nonunion in 22 cases, bone resorption in 14 cases, and postoperative infection in 4 cases. Twenty-eight cases of bone grafting required revision surgery, including replacement of internal fixation, autologous bone graft, debridement, removal of internal fixation, and replacement with prosthetic replacement.Biological reconstructions with massive bone grafts are useful in the reconstruction of certain malignant extremity bone tumors after wide excision.
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Affiliation(s)
- Weitao Yao
- Bone and Soft Department, the Affiliated Cancer Hospital of Zheng Zhou University, He Nan cancer Hospital
| | - Qiqing Cai
- Bone and Soft Department, the Affiliated Cancer Hospital of Zheng Zhou University, He Nan cancer Hospital
| | - Jiaqiang Wang
- Bone and Soft Department, the Affiliated Cancer Hospital of Zheng Zhou University, He Nan cancer Hospital
| | - Peng Zhang
- Bone and Soft Department, the Affiliated Cancer Hospital of Zheng Zhou University, He Nan cancer Hospital
| | - Xin Wang
- Bone and Soft Department, the Affiliated Cancer Hospital of Zheng Zhou University, He Nan cancer Hospital
| | - Xinhui Du
- Bone and Soft Department, the Affiliated Cancer Hospital of Zheng Zhou University, He Nan cancer Hospital
| | - Xiaohui Niu
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking University. Beijing, China, No. 31 Xin Jie Kou Dong Jie, Xi Cheng District, Beijing, China
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Abstract
BACKGROUND Limb salvage surgery with endoprosthesis for bone tumor around the knee is reported to have good functional and oncological outcomes. However, the functional assessment using musculoskeletal tumor society (MSTS) and Toronto extremity scoring system remains subjective. We performed gait analysis as an objective assessment of their functional outcome. MATERIALS AND METHODS Gait analysis was performed in 20 patients with endoprosthesis replacement around the knee. The temporal parameters assessed during gait analysis were walking velocity, stride length, duration of stance, and goniometry of the knee. These parameters were compared with the functional outcome score of the MSTS. RESULTS The mean free-paced walking velocity was 0.91 m/s (normal is 1.33 m/s), which was 68% lower than normal gait. The stride length and stance phase were shorter for the affected limb compared to normal (P < 0.05). However, the gait was symmetrical with no difference in stride length (P = 0.148), velocity (P = 0.918), knee flexion (P = 0.465), and knee extension (P = 0.321) between the affected and unaffected limbs. Sixteen patients demonstrated stiff knee gait, two had a flexed knee gait, and only two patients had normal gait during the stance phase. The mean MSTS score was 21. There was significant correlation between overall MSTS scores (P = 0.023), function (P = 0.039), and walking scores (P = 0.007). CONCLUSION Limb salvage surgery with endoprosthesis reconstruction around the knee gives good functional outcome, both objectively and subjectively, as evidenced by the symmetrical gait pattern and significant correlation with MSTS score. Despite decreased walking velocity, stride length, and stance phase of the operated limb, the patient still has a symmetrical gait.
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Affiliation(s)
- Vivek Ajit Singh
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,Address for correspondence: Prof. Vivek Ajit Singh, Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia, Malaysia. E-mail:
| | - Chan Wei Heng
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nor Faissal Yasin
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Tan TJ, Aljefri AM, Clarkson PW, Masri BA, Ouellette HA, Munk PL, Mallinson PI. Imaging of limb salvage surgery and pelvic reconstruction following resection of malignant bone tumours. Eur J Radiol 2015; 84:1782-90. [PMID: 26104572 DOI: 10.1016/j.ejrad.2015.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/02/2015] [Indexed: 11/16/2022]
Abstract
Advances in reconstructive orthopaedic techniques now allow for limb salvage and prosthetic reconstruction procedures to be performed on patients who would otherwise be required to undergo debilitating limb amputations for malignant bone tumours. The resulting post-operative imaging of such cases can be daunting for the radiologist to interpret, particularly in the presence of distorted anatomy and unfamiliar hardware. This article reviews the indications for limb salvage surgery, prosthetic reconstruction devices involved, expected post-operative imaging findings, as well as the potential hardware related complications that may be encountered in the management of such cases.
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Affiliation(s)
- Tien Jin Tan
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada.
| | - Ahmad M Aljefri
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Paul W Clarkson
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Bassam A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Hugue A Ouellette
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter L Munk
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Paul I Mallinson
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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Teo HEL, Peh WCG. The role of imaging in the staging and treatment planning of primary malignant bone tumors in children. Eur Radiol 2004; 14:465-75. [PMID: 14749946 DOI: 10.1007/s00330-003-2211-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2003] [Revised: 09/16/2003] [Accepted: 12/01/2003] [Indexed: 10/26/2022]
Abstract
The accurate staging of primary bone tumors in children is critical for treatment planning. Limb salvage operations can now be performed with excellent outcomes in suitable patients. The purpose of this article is to review the current state of imaging techniques and their roles in enabling accurate staging and treatment planning to be performed in pediatric patients with primary bone tumors.
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Affiliation(s)
- Harvey E L Teo
- Department of Diagnostic Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899 Singapore.
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de Visser E, Veth RPH, Schreuder HWB, Duysens J, Mulder T. Reorganization of Gait After Limb-Saving Surgery of the Lower Limb. Am J Phys Med Rehabil 2003; 82:825-31. [PMID: 14566148 DOI: 10.1097/01.phm.0000091981.41025.fc] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In this study, the concept of a cognitive dual-task performance and visual restriction during walking has been used to study the recovery of gait after limb-saving surgery in ten patients. DESIGN All patients were recovering from some form of treatment to tumors of the lower limbs. Patients had to walk on a treadmill at their preferred speed. During the course of recovery, we measured normal walking, walking while performing an attention-demanding dual task, and walking during restricted vision, starting 5 mo postoperatively. RESULTS Patients are able to reach an acceptable level of gait within 15 mo, especially when the basic locomotor activity (i.e., step-cycle duration, walking speed, gait symmetry) is taken into account. Nevertheless, the results showed that during the recovery, the patients were still hindered by the dual task and visual restriction while walking because they exhibited a decrease in step-cycle duration under these conditions. CONCLUSIONS In general, an improvement in walking speed and a decrease in asymmetry was seen. On the other hand, patients still had a basically reduced control of gait after the 15-mo recovery period. This can be attributed to a lack of gait automatism caused by an irreversible loss of somatosensory input.
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Affiliation(s)
- Enrico de Visser
- Department of Orthopaedics, Nijmegen University Medical Centre, The Netherlands
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Abstract
Since the early 1970s, substantial progress in dealing with musculoskeletal tumours has been made, with improvements in surgical skills, radiology, chemotherapy, pathology, and radiotherapy. Nowadays, 70-85% of all malignant tumours are treated by limb salvage, without compromising the oncological result. After many years, the functional result that may be achieved with a limb-saving procedure is becoming clear. Limb salvage has cosmetic advantages, but whether the quality of life of these patients is superior to that of those who undergo amputation is unclear. The non-oncological complication rate is much higher after limb salvage than after amputation, and consequently additional surgery is necessary. In the future, the co-operating disciplines should strive for better survival of these patients, for which the development of new chemotherapeutic drugs is especially needed.
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de Visser E, Deckers JA, Veth RP, Schreuder HW, Mulder TW, Duysens J. Deterioration of balance control after limb-saving surgery. Am J Phys Med Rehabil 2001; 80:358-65. [PMID: 11327558 DOI: 10.1097/00002060-200105000-00007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluation of the changes in balance control observed in patients after limb-saving surgery for malignant tumors of the lower limb. DESIGN Case series. RESULTS In 11 patients who underwent limb-saving surgery and 10 healthy, age-matched controls, displacement of the amplitude of the center of pressure (ACP) and velocity of the center of pressure (VCP) during normal standing and standing on a balance board were registered. Adding such constraints as standing with eyes closed and performing a Stroop task made standing more complex. During normal standing and on the balance board, both groups showed comparable ACP and VCP values. With eyes closed, both patients and controls showed a higher amplitude and velocity in the anterior-posterior direction. In the patient group, the Stroop task affected the ACP (4.5 +/- 0.8 mm) compared with normal standing (2.9 +/- 0.4 mm) and VCP (18.6 +/- 3.0 mm/sec) compared with normal standing (11.9 +/- 1.0 mm/sec). During balance board standing, the authors found a difference in the VCP for both groups whose eyes were closed and who performed under dual-task conditions (controls, 23.2 +/- 3.3 and 14.9 +/- 2.9 mm/sec; patients, 80.1 +/- 12.9 and 23.6 +/- 3.4 mm/sec). CONCLUSIONS Although the patient group showed impressive upright standing after limb-saving surgery, upright standing become more difficult under higher visual and cognitive loads. This finding indicates that the level of postural automatism is not complete in these patients.
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Affiliation(s)
- E de Visser
- Department of Medicine and Biophysics, University of Nijmegen, The Netherlands
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De Visser E, Mulder T, Schreuder HW, Veth RP, Duysens J. Gait and electromyographic analysis of patients recovering after limb-saving surgery. Clin Biomech (Bristol, Avon) 2000; 15:592-9. [PMID: 10936431 DOI: 10.1016/s0268-0033(00)00021-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Control of gait after limb-saving surgery.Design. Case series study. BACKGROUND At the moment little is known about adaptations in patients' gait after limb-saving surgery. METHODS Nineteen patients who underwent limb-saving surgery at least 1 yr earlier and 10 normal subjects were studied during treadmill walking. The main outcome measures were walking speed, step parameters and angular displacement of both legs and EMG of the biceps femoris, rectus femoris and medial gastrocnemius in the affected leg. RESULTS Preferred walking speed in the patients was lower than in the controls (0.7 versus 1.1 m/s). Furthermore, stance phase of the non-affected leg was lengthened. All patients showed reduced stance phase knee flexion in the affected leg, while during the swing phase no difference was seen. The EMG signals of the rectus femoris and biceps femoris show changes, which are related to the location of surgery. CONCLUSIONS The results showed that the gait pattern of the patients differed compared to normal gait. The reduced stance phase knee flexion in the hip group is based on a high degree of co-contraction between quadriceps and hamstring activity, while in the knee group this is based on the quadriceps avoidance pattern. The finding that there is still side-to-side asymmetry indicates that there is no complete reorganisation following the massive loss of input and output of the leg. It is possible that some reprogramming of the locomotor process occur. RELEVANCE Gait and electromyographic analysis are essential for the quantitative assessments of the functional outcome in this type of surgery.
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Affiliation(s)
- E De Visser
- Department of Orthopaedics, University Hospital Nijmegen, The Netherlands
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Renard AJ, Veth RP, Schreuder HW, van Loon CJ, Koops HS, van Horn JR. Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol 2000; 73:198-205. [PMID: 10797332 DOI: 10.1002/(sici)1096-9098(200004)73:4<198::aid-jso3>3.0.co;2-x] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES The functional results and the complications after several limb-saving and ablative treatments because of lower extremity bone sarcoma were evaluated. METHODS Seventy-seven surviving patients were evaluated according to the MSTS (American Musculoskeletal Tumor Society) functional rating system. Fifty-two patients had limb-saving and 25 had ablative therapy. Median follow-up was 97 months in the limb-saving group and 112 months in the ablative group. RESULTS Functional results in the limb-saving group were significantly better than in the ablative group (P = 0.0001). Functional results in patients with tumors about the knee joint were significantly better (P = 0.0064) after limb-saving surgery (i.e., endoprosthesis, knee arthrodesis, or rotationplasty) compared to functional results after ablative surgery (i.e., hip or knee disarticulation or above-the-knee amputation). Complications were 3 times more common after limb-salvage procedures and 4 times more common after endoprosthetic reconstructions compared to after ablative procedures. Complications after limb-saving therapy were fewest in tumors about the knee joint. In 3/28 patients, the endoprosthetic reconstruction had to be converted to an amputation. CONCLUSIONS Functional results were significantly better after limb-saving compared to after ablative therapy. Complications, however, were more common after limb-saving therapy.
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Affiliation(s)
- A J Renard
- Department of Orthopaedics, Nijmegen University Hospital, Nijmegen, The Netherlands
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Affiliation(s)
- W C Peh
- Department of Diagnostic Radiology, University of Hong Kong, Queen Mary Hospital.
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16
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Ham SJ, Schraffordt Koops H, van der Graaf WT, van Horn JR, Postma L, Hoekstra HJ. Historical, current and future aspects of osteosarcoma treatment. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1998; 24:584-600. [PMID: 9870738 DOI: 10.1016/s0748-7983(98)93896-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- S J Ham
- Department of Orthopaedic Surgery, Groningen University Hospital, The Netherlands
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de Visser E, Pauwels J, Duysens JE, Mulder T, Veth RP. Gait adaptations during walking under visual and cognitive constraints: a study of patients recovering from limb-saving surgery of the lower limb. Am J Phys Med Rehabil 1998; 77:503-9. [PMID: 9862537 DOI: 10.1097/00002060-199811000-00010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this case series study was reautomatization of gait after limb-saving surgery for tumors at a laboratory of gait analysis. Twelve patients (9 males and 3 females; mean age, 38 years) who underwent limb-saving surgery of the lower limb at least 1 year previously and ten normal subjects (3 males and 7 females; mean age, 37.5 years) were studied. The main outcome measures were walking speed and stride time duration under normal walking conditions as well as the use of different types of constraints. Patients walked with a lower preferred walking speed than the normal subjects. Patients showed a higher coefficient of variation of stride time in normal walking as well as complex walking compared with normal subjects. During walking with constraints, a significant decrease in stride time was found in patients but not in normal subjects. Although restoration of gait after limb-saving surgery is impressive, it is not complete (lower walking speed) and can break down under conditions of visual and cognitive load. Hence, the application of complex tasks reveals that gait reautomatization is not complete in these patients during a period of 2 to 5 years after surgery.
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Affiliation(s)
- E de Visser
- Department of Orthopedics, University Hospital Nijmegen, The Netherlands
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