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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 6, 786-794.
doi: 10.1302/0301-620X.90B6.19805  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Right arrow Articles by Aksnes, L. H.
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Limb-sparing surgery preserves more function than amputation

A SCANDINAVIAN SARCOMA GROUP STUDY OF 118 PATIENTS

L. H. Aksnes, MD, Oncologist1; H. C. F. Bauer, MD, PhD, Professor, Orthopaedic Surgeon2; N. L. Jebsen, MD, Oncologist, Centre for Bone and Soft Tissue Tumours3; G. Follerås, MD, Orthopaedic Surgeon4; C. Allert, Physiotherapist5; G. S. Haugen, Physiotherapist6; and K. S. Hall, MD, PhD, Oncologist1

1 Department of Oncology
2 Orthopedic Oncology Service
3 Haukeland University Hospital, 5021 Bergen, Norway.
4 Department of Surgery
5 Department of Physiotherapy Karolinska University Hospital, SE-17176 Stockholm, Sweden.
6 Division of Rehabilitation The Norwegian Radium Hospital, Rikshospitalet University Hospital, Montebello, 0310 Oslo, Norway.

Correspondence should be sent to Dr L. H. Aksnes; e-mail: liv.hege.aksnes{at}radiumhospitalet.no

We evaluated the long-term functional outcome in 118 patients treated for osteosarcoma or Ewing’s sarcoma in the extremities a minimum of five years after treatment. We also examined if impaired function influenced their quality of life and ability to work.

The function was evaluated according to the Musculoskeletal Tumor Society (MSTS) score and the Toronto Extremity Salvage Score (TESS). Quality of life was assessed by using the Short Form-36 (SF-36).

The mean age at follow-up was 31 years (15 to 57) and the mean follow-up was for 13 years (6 to 22). A total of 67 patients (57%) initially had limb-sparing surgery, but four had a secondary amputation. The median MSTS score was 70% (17% to 100%) and the median TESS was 89% (43% to 100%). The amputees had a significantly lower MSTS score than those with limb-sparing surgery (p < 0.001), but there was no difference for the TESS. Tumour localisation above knee level resulted in significantly lower MSTS scores and TESS (p = 0.003 and p = 0.02, respectively).

There were no significant differences in quality of life between amputees and those with limb-sparing surgery except in physical functioning. Of the patients 11% (13) did not work or study. In multivariate analysis, amputation, tumour location above the knee and having muscular pain were associated with low physical function.

We conclude that most of the bone tumour survivors managed well after adjustment to their physical limitations. A total of 105 are able to work and have an overall good quality of life.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General