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What Sports Activity Levels Are Achieved in Patients With Modular Tumor Endoprostheses of Osteosarcoma About the Knee?

  • Symposium: 2013 Meetings of the Musculoskeletal Tumor Society and the International Society of Limb Salvage
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 20 August 2014

Abstract

Background

Advances in multimodal treatment have improved survival of patients with nonmetastatic osteosarcoma. At the same time, implant design has improved the outcomes of limb salvage with modular endoprostheses. However, little is known about sports activity in long-term survivors with osteosarcoma.

Questions/purposes

We wanted to evaluate (1) sports activity levels in long-term survivors of osteosarcoma about the knee who received a modular tumor endoprosthesis; (2) to determine if activity level changed over time from initial reconstruction or (3) was predicted from sports activity level before diagnosis; and (4) if complications that occurred affected sports or contributed to prosthetic failures.

Methods

Between 1995 and 2005, we treated 120 patients for osteosarcoma about the knee with resection and modular endoprosthetic reconstruction; of those, 25 (21%) have died, six (5%) had an amputation, 39 (32%) did not speak German and so were ineligible, and 14 (12%) were either lost to followup or refused to participate, leaving 27 patients (14 females, 13 males; median age 19 years [range, 12–60 years); average followup 11 ± 4 years) (54% of the living, German-speaking cohort) for this analysis. Tumors were located in the distal femur (n = 16) and the proximal tibia (n = 11). Sports participation as well as the UCLA Activity Score and the modified Weighted Activity Score were assessed retrospectively. Moreover, postoperative complications were evaluated.

Results

Before the diagnosis of osteosarcoma and 1, 3, and 5 years and at the latest followup, respectively, after their reconstructions, 24 (89%), nine (33%), 20 (74%), and 24 patients (89%) were able to perform sports activities. There was a reduction in high-impact activities. Those patients with followup longer than 5 years had no changes in sports activity at their latest followup. Patients who had higher levels of sports activity levels before surgery generally had higher levels of activity at last followup (UCLA Activity Score: r = 0.62, p < 0.0005; modified Weighted Activity Score r = 0.49, p < 0.01). Fourteen patients (51%) underwent revision surgery. With the numbers available, complications had no effect on sports activity. No sports activity-related complications were found.

Conclusions

Some long-term survivors of osteosarcoma can achieve high levels of sports activity. Preoperative activity levels seem to influence the postoperative activity levels. This information is important to give realistic expectations for long-term survivors of osteosarcoma of the knee.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Adamsen L, Andersen C, Midtgaard J, Moller T, Quist M, Rorth M. Struggling with cancer and treatment: young athletes recapture body control and identity through exercise: qualitative findings from a supervised group exercise program in cancer patients of mixed gender undergoing chemotherapy. Scand J Med Sci Sports. 2009;19:55–66.

    Article  CAS  PubMed  Google Scholar 

  2. Adamsen L, Quist M, Midtgaard J, Andersen C, Moller T, Knutsen L, Tveteras A, Rorth M. The effect of a multidimensional exercise intervention on physical capacity, well-being and quality of life in cancer patients undergoing chemotherapy. Support Care Cancer. 2006;14:116–127.

    Article  PubMed  Google Scholar 

  3. Bielack S, Kempf-Bielack B, Schwenzer D, Birkfellner T, Delling G, Ewerbeck V, Exner GU, Fuchs N, Gobel U, Graf N, Heise U, Helmke K, von Hochstetter AR, Jurgens H, Maas R, Munchow N, Salzer-Kuntschik M, Treuner J, Veltmann U, Werner M, Winkelmann W, Zoubek A, Kotz RI. [Neoadjuvant therapy for localized osteosarcoma of extremities. Results from the Cooperative osteosarcoma study group COSS of 925 patients] [in German]. Klin Padiatr. 1999;211:260–270.

    Article  CAS  PubMed  Google Scholar 

  4. Carrle D, Bielack SS. Current strategies of chemotherapy in osteosarcoma. Int Orthop. 2006;30:445–451.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Chatterji U, Ashworth MJ, Lewis PL, Dobson PJ. Effect of total knee arthroplasty on recreational and sporting activity. ANZ J Surg. 2005;75:405–408.

    Article  PubMed  Google Scholar 

  6. Dominkus M, Sabeti M, Toma C, Abdolvahab F, Trieb K, Kotz RI. Reconstructing the extensor apparatus with a new polyester ligament. Clin Orthop Relat Res. 2006;453:328–334.

    Article  PubMed  Google Scholar 

  7. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241–246.

    PubMed  Google Scholar 

  8. Frances JM, Morris CD, Arkader A, Nikolic ZG, Healey JH. What is quality of life in children with bone sarcoma? Clin Orthop Relat Res. 2007;459:34–39.

    Article  PubMed  Google Scholar 

  9. Geller DS, Gorlick R. Osteosarcoma: a review of diagnosis, management, and treatment strategies. Clin Adv Hematol Oncol. 2010;8:705–718.

    PubMed  Google Scholar 

  10. Healy WL, Iorio R, Lemos MJ. Athletic activity after joint replacement. Am J Sports Med. 2001;29:377–388.

    CAS  PubMed  Google Scholar 

  11. Healy WL, Sharma S, Schwartz B, Iorio R. Athletic activity after total joint arthroplasty. J Bone Joint Surg Am. 2008;90:2245–2252.

    Article  PubMed  Google Scholar 

  12. Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, Windhager R, Kotz RI, Mercuri M, Funovics PT, Hornicek FJ, Temple HT, Ruggieri P, Letson GD. Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am. 2011;93:418–429.

    Article  PubMed  Google Scholar 

  13. Luetke A, Meyers PA, Lewis I, Juergens H. Osteosarcoma treatment—where do we stand? A state of the art review. Cancer Treat Rev. 2014;40:523–532.

    Article  PubMed  Google Scholar 

  14. Mittermayer F, Krepler P, Dominkus M, Schwameis E, Sluga M, Heinzl H, Kotz R. Long-term followup of uncemented tumor endoprostheses for the lower extremity. Clin Orthop Relat Res. 2001;388:167–177.

    Article  PubMed  Google Scholar 

  15. Mondloch MV, Cole DC, Frank JW. Does how you do depend on how you think you’ll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes. CMAJ. 2001;165:174–179.

    CAS  PubMed Central  PubMed  Google Scholar 

  16. Mont MA, Marker DR, Seyler TM, Gordon N, Hungerford DS, Jones LC. Knee arthroplasties have similar results in high- and low-activity patients. Clin Orthop Relat Res. 2007;460:165–173.

    PubMed  Google Scholar 

  17. Murray DG. Total knee arthroplasty. Clin Orthop Relat Res. 1985;192:59–68.

    PubMed  Google Scholar 

  18. Papalia R, Del Buono A, Zampogna B, Maffulli N, Denaro V. Sport activity following joint arthroplasty: a systematic review. Br Med Bull. 2012;101:81–103.

    Article  PubMed  Google Scholar 

  19. Sheiko M, Bjornson K, Lisle J, Song K, Eary JF, Conrad EU 3rd. Physical activity assessment in adolescents with limb salvage. J Pediatr. 2012;161:1138–1141.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Steptoe A, Butler N. Sports participation and emotional wellbeing in adolescents. Lancet. 1996;347:1789–1792.

    Article  CAS  PubMed  Google Scholar 

  21. Whelan J, Seddon B, Perisoglou M. Management of osteosarcoma. Curr Treat Options Oncol. 2006;7:444–455.

    Article  PubMed  Google Scholar 

  22. Winkler K, Bielack S, Delling G, Salzer-Kuntschik M, Kotz R, Greenshaw C, Jurgens H, Ritter J, Kusnierz-Glaz C, Erttmann R. Effect of intraarterial versus intravenous cisplatin in addition to systemic doxorubicin, high-dose methotrexate, and ifosfamide on histologic tumor response in osteosarcoma (study COSS-86). Cancer. 1990;66:1703–1710.

    Article  CAS  PubMed  Google Scholar 

  23. Winter C, Muller C, Brandes M, Brinkmann A, Hoffmann C, Hardes J, Gosheger G, Boos J, Rosenbaum D. Level of activity in children undergoing cancer treatment. Pediatr Blood Cancer. 2009;53:438–443.

    Article  PubMed  Google Scholar 

  24. Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplasty. 1998;13:890–895.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank Prof M. Dominkus for being in charge of the local tumor registry for many years providing necessary basic information. Furthermore, we thank the former and present secretaries of the tumor registry, Mag. T. Zettl and O. Wallner, respectively.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Medical University of Vienna, 1090, Vienna, Austria

    Nikolaus W. Lang MD, Gerhard M. Hobusch MD, Philipp T. Funovics MD, Reinhard Windhager MD & Jochen G. Hofstaetter MD

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  1. Nikolaus W. Lang MD
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  2. Gerhard M. Hobusch MD
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  3. Philipp T. Funovics MD
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  4. Reinhard Windhager MD
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  5. Jochen G. Hofstaetter MD
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Corresponding author

Correspondence to Gerhard M. Hobusch MD.

Additional information

One of the authors certifies that he (RW) may receive payments or benefits of less than USD 10,000, during the study period, from Stryker Osteonics (Kiel, Germany).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Lang, N.W., Hobusch, G.M., Funovics, P.T. et al. What Sports Activity Levels Are Achieved in Patients With Modular Tumor Endoprostheses of Osteosarcoma About the Knee?. Clin Orthop Relat Res 473, 847–854 (2015). https://doi.org/10.1007/s11999-014-3788-2

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  • DOI: https://doi.org/10.1007/s11999-014-3788-2

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