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Filis P, Varvarousis D, Ntritsos G, Dimopoulos D, Filis N, Giannakeas N, Korompilias A, Ploumis A. Rotationplasty outcomes assessed by gait analysis following resection of lower extremity bone neoplasms. Bone Jt Open 2023; 4:817-824. [PMID: 37907080 PMCID: PMC10618047 DOI: 10.1302/2633-1462.411.bjo-2023-0101.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Aims The standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the patients and incidences of phantom pain. Rotationplasty had arisen as a potent limb salvage treatment option for young cancer patients with lower limb bone tumours, but its impact on the gait through comparative studies still remains unclear several years after the introduction of the procedure. The aim of this study is to assess the effect of rotationplasty on gait parameters measured by gait analysis compared to healthy individuals. Methods The MEDLINE, Scopus, and Cochrane databases were systematically searched without time restriction until 10 January 2022 for eligible studies. Gait parameters measured by gait analysis were the outcomes of interest. Results Three studies were eligible for analyses. Compared to healthy individuals, rotationplasty significantly decreased gait velocity (-1.45 cm/sec; 95% confidence interval (CI) -1.98 to -0.93; p < 0.001), stride length (-1.20 cm; 95% CI -2.31 to -0.09; p < 0.001), cadence (-0.83 stride/min; 95% (CI -1.29 to -0.36; p < 0.001), and non-significantly increased cycle time (0.54 sec; 95% CI -0.42 to 1.51; p = 0.184). Conclusion Rotationplasty is a valid option for the management of lower limb bone tumours in young cancer patients. Larger studies, with high patient accrual, refined surgical techniques, and well planned rehabilitation strategies, are required to further improve the reported outcomes of this procedure.
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Affiliation(s)
- Panagiotis Filis
- Department of Medical Oncology, University of Ιoannina, Ιoannina, Greece
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Dimitrios Varvarousis
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
| | - Georgios Ntritsos
- Department of Informatics and Telecommunications, University of Ioannina, Arta, Greece
| | - Dimitrios Dimopoulos
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
| | - Nikolaos Filis
- Medical School, University of Ioannina, Ιoannina, Greece
| | - Nikolaos Giannakeas
- Department of Informatics and Telecommunications, University of Ioannina, Arta, Greece
| | - Anastasios Korompilias
- Division of Orthopaedic Surgery, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
| | - Avraam Ploumis
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
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Banskota N, Fang X, Yuan D, Zhang W, Duan H. Comparative study of gait parameters of patients undergoing distal femoral resections with non-operated and healthy limbs: a meta-analysis study. Front Oncol 2023; 13:1089609. [PMID: 37810986 PMCID: PMC10552754 DOI: 10.3389/fonc.2023.1089609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Gait analysis is one of the most important components of functional outcome evaluation in patients with lower-extremity tumors. Disparities between operated limbs when compared with non-operated limbs and healthy populations based on gait parameters have rarely been studied. In the present study, we attempted to analyze the gait difference and its impacts on daily life. Methods The gait parameters of distal femoral tumor-resected patients were collected from PubMed, CNKI, MEDLINE, Embase, Cochrane, and Google Scholar till September 30, 2022, by strictly following the inclusion and exclusion criteria. Differences between gait parameters in the operated and non-operated limbs or healthy limbs of distal femoral tumor patients were analyzed based on stance phase, swing phase, cadence, and velocity. The fixed-effects and random-effects models were used to conduct a meta-analysis. Results Six studies were included according to the selection criteria. There were 224 patients in total in these studies. Standard mean differences were calculated for all of our outcomes. Our results showed that there was a minimal difference in the standard mean difference of gait parameters between operated and non-operated limbs and healthy limbs. Conclusion Distal femoral tumor resections have been associated with deficient muscle function and strength and impaired gait parameters. Minimal differences in the gait parameters highlighted the advantage of distal femoral resection when replaced with a prosthesis.
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Affiliation(s)
| | | | | | - Wenli Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Duan
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Johansen ML, Eriksrud O, Thorkildsen J, Norum OJ, Wisløff T, Taksdal I, Nilsen TS. Muscle strength characteristics following megaprosthetic knee reconstruction for bone sarcoma. Surg Oncol 2023; 48:101944. [PMID: 37062091 DOI: 10.1016/j.suronc.2023.101944] [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: 12/20/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE To assess muscle strength characteristics in patients with resection and megaprosthetic reconstruction of the knee for bone sarcoma compared to age- and sex-matched controls. METHODS This was a cross-sectional, case-control study. Muscle strength characteristics for knee extension and -flexion were assessed isokinetically at three different joint velocities: 60, 120 and 180°/s, and by the rate of force development (RDFmax) in knee extension. The Toronto Extremity Salvage Score (TESS) was used in patients. RESULTS Eighteen patients (91.6 months postop.) and 18 controls were included. Relative to controls, patients generated maximal torques of 19%, 23% and 23% in knee extension at 60, 120 and 180°/s, respectively. For knee flexion, patients generated maximal torques of 58%, 53% and 60% at 60, 120, and 180°/s, relative to the controls. RDFmax of the operated leg was 2.75 ± 2.13 N/ms, 7.16 ± 4.78 N/ms for the non-operated leg, and 7.95 ± 4.29 N/ms for the controls. The mean TESS score was 84.0. CONCLUSION Patients reached approximately 20% of the maximal knee extension torque. In isometric assessments, they used double the amount of time to generate one-third of the maximal force compared to the controls despite good TESS scores.
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Affiliation(s)
- Merethe Lia Johansen
- Division of Cancer Medicine, Department of Clinical Service, Section for Cancer Rehabilitation, Oslo University Hospital, Oslo, Norway.
| | - Ola Eriksrud
- Institute of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Ole-Jacob Norum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Ingeborg Taksdal
- Division of Radiology and Nuclear Medicine, Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Tormod S Nilsen
- Institute of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
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Gait, Function, and Strength Following Lower Limb Salvage Surgery for a Primary Malignant Bone Tumor: A Systematic Review. REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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AlDossary NM, Ostler C, Donovan-Hall M, Metcalf CD. Non-oncological outcomes following limb salvage surgery in patients with knee sarcoma: a scoping review. Disabil Rehabil 2021; 44:4531-4545. [PMID: 33756091 DOI: 10.1080/09638288.2021.1900409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Limb salvage surgery is a surgical procedure for tumour resection in bone and soft-tissue cancers. Guidelines aim to preserve as much function and tissue of the limb as possible. Surgical outcome data is routinely available as part of surgical reporting processes. What is less known are important non-oncological outcomes throughout recovery from both clinical and patient perspectives. The objective of this review was to explore non-oncological outcomes in patients diagnosed with sarcoma around the knee following limb salvage surgery. Materials and Methods: A scoping review methodology was used, and results analysed using CASP checklists. Results: Thirteen studies were included and following appraisal and synthesis, three themes emerged as providing important measures intrinsic to successful patient recovery: (1) physical function, (2) quality of life and, (3) gait and knee goniometry. Specifically, patients develop range of motion complications that alter gait patterns and patients often limit their post-operative participation in sport and leisure activities. Conclusions: This study has shown the importance of exploring confounding factors, adopting a holistic view of patient recovery beyond surgical outcomes, proposing evidence-based guidance to support and inform healthcare providers with clinical decision-making. This review highlights the paucity and lack of quality of research available, emphasising how under-represented this population is in the research literature.IMPLICATIONS FOR REHABILITATIONPatients having undergone LSS often have limited participation in sport and leisure activities.Patients can develop range of motion complications, such as flexion contracture or extension lag, which may affect the pattern of gait.Clinical consideration should be given to walking ability and gait patterns during the rehabilitation phase to prevent poor functional outcomes during recovery.Variation of treatment protocols, outcome measurement and rehabilitative care has been identified as important in predicting the outcomes in recovery from LSS procedures.
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Affiliation(s)
- Nafla M AlDossary
- Physical Therapy Department, King Fahad Specialist Hospital, Dammam City, Saudi Arabia
| | - Chantel Ostler
- Portsmouth Enablement Centre, Portsmouth University Hospitals NHS Trust, Portsmouth, UK.,School of Health Sciences, University of Southampton, Southampton, UK.,Exceed Research Network, Lisburn, UK
| | - Maggie Donovan-Hall
- Portsmouth Enablement Centre, Portsmouth University Hospitals NHS Trust, Portsmouth, UK.,School of Health Sciences, University of Southampton, Southampton, UK
| | - Cheryl D Metcalf
- Portsmouth Enablement Centre, Portsmouth University Hospitals NHS Trust, Portsmouth, UK.,School of Health Sciences, University of Southampton, Southampton, UK
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Gait analysis: Comparative evaluation of conventional total knee replacement and modular distal femoral megaprosthesis. Knee 2020; 27:1567-1576. [PMID: 33010775 DOI: 10.1016/j.knee.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/30/2020] [Accepted: 08/03/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait alterations have been studied with computer-assisted gait analysis after megaprosthetic replacement for tumors around the knee. It has never been proven that megaprostheses affects gait more than total knee arthroplasty (TKA); this study aims to compare via gait analysis patients who underwent megaprosthesis with patients with TKA. METHODS We analyzed 26 patients with a megaprosthetic replacement of the distal femur and 21 patients with a standard TKA. For each subject computerized gait analysis was performed. Range of motion (ROM) of the knee was recorded, Quality of Life and functional evaluation in the oncologic group were assessed with the Musculoskeletal Tumor Society (MSTS) questionnaire, while Short Form-36 (SF-36) scores were calculated for both groups. RESULTS All patients walked slower than healthy people (P < 0.05). Gait analysis showed a lower cadence than in the healthy population but no significant difference between the two groups. A longer swing and a shorter stance phase were detected in the megaprosthetic sample. The osteoarthritis group showed greater flexion during the phase of loading response, even if this was lower than the contralateral limb or healthy population. There was a statically significant difference between the healthy limb and the operated one in both groups regarding ROM, but no significant difference was registered between the two implants. MSTS score and most of SF-36 parameters showed no significant differences compared with literature data. CONCLUSIONS Gait analysis shows little discrepancy between the two groups; gait pattern abnormalities do not affect patients with a megaprosthetic replacement more significantly than patients undergoing TKA.
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Morri M, Bekkering PW, Cotti M, Meneghini M, Venturini E, Longhi A, Mariani E, Forni C. Cross-Cultural Validation of the Italian Version of the Bt-DUX: A Subjective Measure of Health-Related Quality of Life in Patients Who Underwent Surgery for Lower Extremity Malignant Bone Tumour. Cancers (Basel) 2020; 12:cancers12082015. [PMID: 32717924 PMCID: PMC7465526 DOI: 10.3390/cancers12082015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 12/17/2022] Open
Abstract
The purpose of this study was to translate the English bone tumour DUX (Bt-DUX-Eng) questionnaire for lower extremity bone tumour patients, a disease-specific quality of life (QoL) instrument, into Italian and then examine the validity of the Italian version of Bt-DUX (Bt-DUX-It). The adaptation and translation process included forward translation, back-translation, and a review of the back-translation by an expert committee. The Bt-DUX-It was validated in a sample of adolescents treated for lower extremity osteosarcoma in Italy. Assessments included the Bt-DUX, the Toronto Extremity Salvage Score (TESS), and the European Organization for Research and Treatment Core Quality of Life Questionnaire of Cancer Patients (EORTC QLQ-C30). Fifty-one patients with a median age of 20 years (range: 15-25) completed the questionnaires. The mean Bt-DUX score was 70 (range: 16.30-100). The internal consistency of the overall score and that of the Bt-DUX-It was good: Cronbach's α was 0.95. Spearman's correlation coefficient between the Bt-DUX (total and domain scores) and EORTC QLQ C30 and TESS were overall moderate to good, reaching a p-value <0.01 in all cases. The Bt-DUX-It version is a useful tool for measuring QoL in patients with bone tumour and has similar internal consistency, construct validity, and discrimination as those of the Dutch and English versions.
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Affiliation(s)
- Mattia Morri
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.C.); (M.M.); (E.V.); (C.F.)
- Correspondence: ; Tel.: +39-051-6366354
| | - Peter Willem Bekkering
- Pediatric Physical Therapist & Postdoc researcher, Máxima sports & movement center, Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands;
| | - Marco Cotti
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.C.); (M.M.); (E.V.); (C.F.)
| | - Matilde Meneghini
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.C.); (M.M.); (E.V.); (C.F.)
| | - Enrico Venturini
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.C.); (M.M.); (E.V.); (C.F.)
| | - Alessandra Longhi
- Department of Chemotherapy, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Elisabetta Mariani
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Cristiana Forni
- Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.C.); (M.M.); (E.V.); (C.F.)
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Puri A. Musculoskeletal Oncology: Finding Its Place in the Sun! Indian J Orthop 2018; 52:1-2. [PMID: 29416162 PMCID: PMC5791224 DOI: 10.4103/ortho.ijortho_674_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Ajay Puri
- Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, Maharashtra, India,Address for correspondence: Prof. Ajay Puri, Department of Surgical Oncology, Room No: 45, Tata Memorial Hospital, HBNI, Mumbai, Maharashtra, India. E-mail:
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