Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 6 , Pages 1039-1047 , June 2009

Functional Outcomes After Limb-Salvage Surgery and Endoprosthetic Reconstruction With an Expandable Prosthesis: A Report of 4 Cases

Presented to the American Academy of Physical Medicine and Rehabilitation, November 20–23, 2008, San Diego, CA.

  • Kathleen Beebe, MD

      Affiliations

    • Department of Orthopaedics, University of Medicine and Dentistry of New Jersey, Newark, NJ
    • Corresponding Author InformationReprint requests to Kathleen Beebe, MD, UMDNJ Ambulatory Care Center, 140 Bergen St, Ste D1610, Newark, NJ 07305
    • ,
  • Kimberly J. Song, MA

      Affiliations

    • Department of Orthopaedics, University of Medicine and Dentistry of New Jersey, Newark, NJ
    • ,
  • Ellen Ross, PhD, PT

      Affiliations

    • Department of Physical Therapy, University of Medicine and Dentistry of New Jersey, Newark, NJ
    • Deceased.
    • ,
  • Benjamin Tuy, MD

      Affiliations

    • Department of Orthopaedics, University of Medicine and Dentistry of New Jersey, Newark, NJ
    • ,
  • Francis Patterson, MD

      Affiliations

    • Department of Orthopaedics, University of Medicine and Dentistry of New Jersey, Newark, NJ
    • ,
  • Joseph Benevenia, MD

      Affiliations

    • Department of Orthopaedics, University of Medicine and Dentistry of New Jersey, Newark, NJ

References 

  1. Yaw KM. Pediatric bone tumors. Semin Surg Oncol. 1999;16:173–183
  2. Bielack SS, Kempf-Bielack B, Delling G, et al. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol. 2002;20:776–790
  3. Marcove RC, Miké V, Hajek JV, Levin AG, Hutter RV. Osteogenic sarcoma under the age of twenty-one (A review of one hundred and forty-five operative cases). J Bone Joint Surg Am. 1970;52:411–423
  4. Bernstein M, Kovar H, Paulussen M, et al. Ewing's sarcoma family of tumors: current management. Oncologist. 2006;11:503–519
  5. Eilber FR, Eckhardt J, Morton DL. Advances in the treatment of sarcomas of the extremity (Current status of limb salvage). Cancer. 1984;54(11 Suppl):2695–2701
  6. Marcove RC, Rosen G. En bloc resections for osteogenic sarcoma. Cancer. 1980;45:3040–3044
  7. Mankin HJ, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW. Long-term results of allograft replacement in the management of bone tumors. Clin Orthop Relat Res. 1996;(324):86–97Mar
  8. Fuchs B, Sim FH. Rotationplasty about the knee: surgical technique and anatomical considerations. Clin Anat. 2004;17:345–353
  9. DiCaprio MR, Friedlaender GE. Malignant bone tumors: limb sparing versus amputation. J Am Acad Orthop Surg. 2003;11:25–37
  10. Agarwal M, Puri A, Anchan C, Shah M, Jambhekar N. Rotationplasty for bone tumors: is there still a role?. Clin Orthop Relat Res. 2007;(459):76–81Jun
  11. Hillmann A, Hoffmann C, Gosheger G, Krakau H, Winkelmann W. Malignant tumor of the distal part of the femur or the proximal part of the tibia: endoprosthetic replacement or rotationplasty. Functional outcome and quality-of-life measurements. J Bone Joint Surg Am. 1999;81:462–468
  12. Gebert C, Hardes J, Vieth V, Hillmann A, Winkelmann W, Gosheger G. The effect of rotationplasty on the ankle joint: long-term results. Prosthet Orthot Int. 2006;30:316–323
  13. Kenan S, Bloom N, Lewis MM. Limb-sparing surgery in skeletally immature patients with osteosarcoma (The use of an expandable prosthesis). Clin Orthop Relat Res. 1991;(270):223–230Sep
  14. Lewis MM. The use of an expandable and adjustable prosthesis in the treatment of childhood malignant bone tumors of the extremity. Cancer. 1986;57:499–502
  15. Wilkins RM, Soubeiran A. The Phenix expandable prosthesis: early American experience. Clin Orthop Relat Res. 2001;(382):51–58Jan
  16. Neel MD, Wilkins RM, Rao BN, Kelly CM. Early multicenter experience with a noninvasive expandable prosthesis. Clin Orthop Relat Res. 2003;415:72–81
  17. Enneking WF, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;(286):241–246Jan
  18. Davis AM, Wright JG, Williams JI, Bombardier C, Griffin A, Bell RS. Development of a measure of physical function for patients with bone and soft tissue sarcoma. Qual Life Res. 1996;5:508–516
  19. Ginsberg JP, Rai SN, Carlson CA, et al. A comparative analysis of functional outcomes in adolescents and young adults with lower-extremity bone sarcoma. Pediatr Blood Cancer. 2007;49:964–969
  20. Davis AM, Bell RS, Badley EM, Yoshida K, Williams JI. Evaluating functional outcome in patients with lower extremity sarcoma. Clin Orthop Relat Res. 1999;(358):90–100Jan
  21. Marchese VG, Ogle S, Womer RB, Dormans J, Ginsberg JP. An examination of outcome measures to assess functional mobility in childhood survivors of osteosarcoma. Pediatr Blood Cancer. 2004;42:41–45
  22. Brazier JE, Harper R, Jones NM, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992;305:160–164
  23. McHorney CA, Ware JE, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31:247–263
  24. McHorney CA, Ware JE, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994;32:40–66
  25. Holm I, Bolstad B, Lütken T, Ervik A, Røkkum M, Steen H. Reliability of goniometric measurements and visual estimates of hip ROM in patients with osteoarthrosis. Physiother Res Int. 2000;5:241–248
  26. Clapper MP, Wolf SL. Comparison of the reliability of the Orthoranger and the standard goniometer for assessing active lower extremity range of motion. Phys Ther. 1988;68:214–218
  27. Brosseau L, Balmer S, Tousignant M, et al. Intra- and intertester reliability and criterion validity of the parallelogram and universal goniometers for measuring maximum active knee flexion and extension of patients with knee restrictions. Arch Phys Med Rehabil. 2001;82:396–402
  28. Bandinelli S, Benvenuti E, Del Lungo I, et al. Measuring muscular strength of the lower limbs by hand-held dynamometer: a standard protocol. Aging (Milano). 1999;11:287–293
  29. Stuberg WA, Metcalf WK. Reliability of quantitative muscle testing in healthy children and in children with Duchenne muscular dystrophy using a hand-held dynamometer. Phys Ther. 1988;68:977–982
  30. Schaubert KL, Bohannon RW. Reliability and validity of three strength measures obtained from community-dwelling elderly persons. J Strength Cond Res. 2005;19:717–720
  31. Gerhardt JJ, Russe OA. International SFTR method of measuring and recording joint motion. Chicago: Year Book Medical Publishers Inc; 1975;
  32. Gross MM, Stevenson PJ, Charette SL, Pyka G, Marcus R. Effect of muscle strength and movement speed on the biomechanics of rising from a chair in healthy elderly and young women. Gait Posture. 1998;8:175–185
  33. Pai YC, Rogers MW. Control of body mass transfer as a function of speed of ascent in sit-to-stand. Med Sci Sports Exerc. 1990;22:378–384
  34. Blanc Y, Balmer C, Landis T, Vingerhoets F. Temporal parameters and patterns of the foot roll over during walking: normative data for healthy adults. Gait Posture. 1999;10:97–108
  35. Perron M, Malouin F, Moffet H, McFadyen BJ. Three-dimensional gait analysis in women with a total hip arthroplasty. Clin Biomech (Bristol, Avon). 2000;15:504–515
  36. Mizner RL, Snyder-Mackler L. Altered loading during walking and sit-to-stand is affected by quadriceps weakness after total knee arthroplasty. J Orthop Res. 2005;23:1083–1090
  37. Kawai A, Backus SI, Otis JC, Healey JH. Interrelationships of clinical outcome, length of resection, and energy cost of walking after prosthetic knee replacement following resection of a malignant tumor of the distal aspect of the femur. J Bone Joint Surg Am. 1998;80:822–831
  38. de Visser E, Veth RP, Schreuder HW, Duysens J, Mulder T. Reorganization of gait after limb-saving surgery of the lower limb. Am J Phys Med Rehabil. 2003;82:825–831
  39. 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;77:503–509
  40. 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;15:592–599
  41. Boonstra AM, Schrama JM, Eisma WH, Hof AL, Fidler V. Gait analysis of transfemoral amputee patients using prostheses with two different knee joints. Arch Phys Med Rehabil. 1996;77:515–520
  42. Schmalz T, Blumentritt S, Jarasch R. Energy expenditure and biomechanical characteristics of lower limb amputee gait: the influence of prosthetic alignment and different prosthetic components. Gait Posture. 2002;16:255–263
  43. Guarrera-Bowlby PL, Gentile AM. Form and variability during sit-to-stand transitions: children versus adults. J Mot Behav. 2004;36:104–114
  44. Perry J. Gait analysis: normal and pathological functioning. 1st ed.. Thorofare: SLACK Inc; 1992;
  45. Rompen JC, Ham SJ, Halbertsma JP, van Horn JR. Gait and function in patients with a femoral endoprosthesis after tumor resection: 18 patients evaluated 12 years after surgery. Acta Orthop Scand. 2002;73:439–446
  46. Schenkman M, Berger RA, Riley PO, Mann RW, Hodge WA. Whole-body movements during rising to standing from sitting. Phys Ther. 1990;70:638–648discussion 648-51
  47. Hughes MA, Myers BS, Schenkman ML. The role of strength in rising from a chair in the functionally impaired elderly. J Biomech. 1996;29:1509–1513
  48. Savelberg HH, Fastenau A, Willems PJ, Meijer K. The load/capacity ratio affects the sit-to-stand movement strategy. Clin Biomech (Bristol, Avon). 2007;22:805–812
  49. Lundin TM, Grabiner MD, Jahnigen DW. On the assumption of bilateral lower extremity joint moment symmetry during the sit-to-stand task. J Biomech. 1995;28:109–112
  50. Kawai A, Backus SI, Otis JC, Inoue H, Healey JH. Gait characteristics of patients after proximal femoral replacement for malignant bone tumour. J Bone Joint Surg Br. 2000;82:666–669
  51. Benedetti MG, Catani F, Donati D, Simoncini L, Giannini S. Muscle performance about the knee joint in patients who had distal femoral replacement after resection of a bone tumor (An objective study with use of gait analysis). J Bone Joint Surg Am. 2000;82:1619–1625

 Supported by the Foundation of University of Medicine and Dentistry of New Jersey (grant no. 198-06).

PII: S0003-9993(09)00203-2

doi: 10.1016/j.apmr.2008.12.025

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 6 , Pages 1039-1047 , June 2009

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