Skip to main content
SpringerLink
Log in

Does Limb-salvage Surgery Offer Patients Better Quality of Life and Functional Capacity than Amputation?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Introduction

Patients with aggressive lower extremity musculoskeletal tumors may be candidates for either above-knee amputation or limb-salvage surgery. However, the subjective and objective benefits of limb-salvage surgery compared with amputation are not fully clear.

Questions/Purposes

We therefore compared functional status and quality of life for patients treated with above-knee amputation versus limb-salvage surgery.

Methods

We reviewed 20 of 51 patients aged 15 years and older treated with above-knee amputation or limb-salvage surgery for aggressive musculoskeletal tumors around the knee between 1994 and 2004 as a retrospective cohort study. At last followup we obtained the Physiological Cost Index, the Reintegration to Normal Living Index, SF-36, and the Toronto Extremity Salvage Score questionnaires. The minimum followup was 12 months (median, 56 months; range, 12–108 months).

Results

Compared with patients having above-knee amputation, patients undergoing limb-salvage surgery had superior Physiological Cost Index scores and Reintegration to Normal Living Index. The Toronto Extremity Salvage scores and SF-36 scores were similar in the two groups.

Conclusion

These data suggest that limb-salvage surgery offers better gait efficiency and return to normal living compared with above-knee amputation, but does not improve the patient’s perception of quality of life.

Level of Evidence

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Akahane T, Shimizu T, Isobe K, Yoshimura Y, Fujioka F, Kato H. Evaluation of postoperative general quality of life for patients with osteosarcoma around the knee joint. J Pediatr Orthop B. 2007;16:269–272.

    Article  PubMed  Google Scholar 

  2. Aksnes LH, Bauer HC, Jebsen NL, Folleras G, Allert C, Haugen GS, Hall KS. Limb-sparing surgery preserves more function than amputation: a Scandinavian sarcoma group study of 118 patients. J Bone Joint Surg Br. 2008;90:786–794.

    Article  PubMed  CAS  Google Scholar 

  3. Ayerza MA, Farfalli GL, Aponte-Tinao L, Muscolo DL. Does increased rate of limb-sparing surgery affect survival in osteosarcoma? Clin Orthop Relat Res. 2010;468:2854–2859.

    Article  PubMed  Google Scholar 

  4. Bekkering WP, Vlieland TP, Koopman HM, Schaap GR, Bart Schreuder HW, Beishuizen A, Jutte PC, Hoogerbrugge PM, Anninga JK, Nelissen RG, Taminiau AH. Functional ability and physical activity in children and young adults after limb-salvage or ablative surgery for lower extremity bone tumors. J Surg Oncol. 2011; 103:276–282.

    Article  PubMed  Google Scholar 

  5. Borden EC, Baker LH, Bell RS, Bramwell V, Demetri GD, Eisenberg BL, Fletcher CD, Fletcher JA, Ladanyi M, Meltzer P, O’Sullivan B, Parkinson DR, Pisters PW, Saxman S, Singer S, Sundaram M, van Oosterom AT, Verweij J, Waalen J, Weiss SW, Brennan MF. Soft tissue sarcomas of adults: state of the translational science. Clin Cancer Res. 2003;9:1941–1956.

    PubMed  Google Scholar 

  6. Davis AM, Devlin M, Griffin AM, Wunder JS, Bell RS. Functional outcome in amputation versus limb sparing of patients with lower extremity sarcoma: a matched case-control study. Arch Phys Med Rehabil. 1999;80:615–618.

    Article  PubMed  CAS  Google Scholar 

  7. 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.

    Article  PubMed  CAS  Google Scholar 

  8. Felder-Puig R, Formann AK, Mildner A, Bretschneider W, Bucher B, Windhager R, Zoubek A, Puig S, Topf R. Quality of life and psychosocial adjustment of young patients after treatment of bone cancer. Cancer. 1998;83:69–75.

    Article  PubMed  CAS  Google Scholar 

  9. Fredrickson E, Ruff RL, Daly JJ. Physiological Cost Index as a proxy measure for the oxygen cost of gait in stroke patients. Neurorehabil Neural Repair. 2007;21:429–434.

    Article  PubMed  Google Scholar 

  10. Ginsberg JP, Rai SN, Carlson CA, Meadows AT, Hinds PS, Spearing EM, Zhang L, Callaway L, Neel MD, Rao BN, Marchese VG. A comparative analysis of functional outcomes in adolescents and young adults with lower-extremity bone sarcoma. Pediatr Blood Cancer. 2007;49:964–969.

    Article  PubMed  Google Scholar 

  11. Gottschalk F. Transfemoral amputation: biomechanics and surgery. Clin Orthop Relat Res. 1999;361:15–22.

    Article  PubMed  Google Scholar 

  12. Grimer RJ, Taminiau AM, Cannon SR; Surgical Subcomitte of the European Osteosarcoma Intergroup. Surgical outcomes in osteosarcoma J Bone Joint Surg Br. 2002;84:395–400.

    Article  PubMed  CAS  Google Scholar 

  13. Hagberg K, Tranberg R, Zügner R, Danielsson A. Reproducibility of the physiological cost index among individuals with a lower-limb amputation and healthy adults. Physiother Res Int. 2011;16:92–100.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  CAS  Google Scholar 

  15. Hopyan S, Tan JW, Graham HK, Torode IF. Function and upright time following limb salvage, amputation, and rotationplasty for pediatric sarcoma of bone. J Pediatr Orthop. 2006;26:405–408.

    Article  PubMed  Google Scholar 

  16. Johansen R, Nielsen OS, Keller J. Functional outcome in sarcomas treated with limb-salvage surgery or amputation. Sarcoma. 1998;2:19–23.

    Article  PubMed  CAS  Google Scholar 

  17. Kahle JT, Highsmith MJ, Hubbard SL. Comparison of nonmicroprocessor knee mechanism versus C-Leg on Prosthesis Evaluation Questionnaire, stumbles, falls, walking tests, stair descent, and knee preference. J Rehabil Res Dev. 2008;45:1–14.

    Article  PubMed  Google Scholar 

  18. 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.

    PubMed  CAS  Google Scholar 

  19. Lane JM, Kroll MA, Rossbach PG. New advances and concepts in amputee management after treatment for bone and soft-tissue sarcomas. Clin Orthop Relat Res. 1990;256:22–28.

    PubMed  Google Scholar 

  20. MacGregor J. The objective measurement of physical performance with long-term ambulatory physiological surveillance equipment (LAPSE). In: Stott FD, Reftery EB, Goulding L, eds. ISAM 1979: Proceedings of the Third International Symposium on Ambulatory Monitoring. London, UK: Academic Press; 1979:29–39.

    Google Scholar 

  21. Meyers PA, Gorlick R. Osteosarcoma. Pediatr Clin North Am. 1997;44:973–989.

    Article  PubMed  CAS  Google Scholar 

  22. Nagarajan R. Quality of Life (QOL) in patients with osteosarcoma. Recent Results Cancer Res.2009;179:339–344.

    Article  PubMed  Google Scholar 

  23. Nagarajan R, Clohisy DR, Neglia JP, Yasui Y, Mitby PA, Sklar C, Finklestein JZ, Greenberg M, Reaman GH, Zeltzer L, Robison LL. Function and quality-of-life of survivors of pelvic and lower extremity osteosarcoma and Ewing’s sarcoma: the Childhood Cancer Survivor Study. Br J Cancer. 2004;91:1858–1865.

    Article  PubMed  CAS  Google Scholar 

  24. Nagarajan R, Neglia JP, Clohisy DR, Robison LL. Limb salvage and amputation in survivors of pediatric lower-extremity bone tumors: what are the long-term implications? J Clin Oncol. 2002;20:4493–4501.

    Article  PubMed  Google Scholar 

  25. Ottaviani G, Robert RS, Huh WW, Jaffe N. Functional, psychosocial and professional outcomes in long-term survivors of lower-extremity osteosarcomas: amputation versus limb salvage. Cancer Treat Res. 2009;152:421–436.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  CAS  Google Scholar 

  27. Robert RS, Ottaviani G, Huh WW, Palla S, Jaffe N. Psychosocial and functional outcomes in long-term survivors of osteosarcoma: a comparison of limb-salvage surgery and amputation. Pediatr Blood Cancer. 2010;54:990–999.

    PubMed  Google Scholar 

  28. Rougraff B, Simon M, Kneisl J, Greenberg D, Mankin H. Limb salvage compared with amputation for osteosarcoma of the distal end of the femur: a long-term oncological, functional, and quality-of-life study. J Bone Joint Surg Am. 1994;76:649–656.

    PubMed  CAS  Google Scholar 

  29. Simon MA, Aschliman MA, Thomas N, Mankin HJ. Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur. J Bone Joint Surg Am. 1986;68:1331–1337.

    PubMed  CAS  Google Scholar 

  30. Sugarbaker PH, Barofsky I, Rosenberg SA, Gianola FJ. Quality of life assessment of patients in extremity sarcoma clinical trials. Surgery. 1982;91:17–23.

    PubMed  CAS  Google Scholar 

  31. Ware JR Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30:473–483.

    Article  PubMed  Google Scholar 

  32. Weddington WW Jr, Segraves KB, Simon MA. Psychological outcome of extremity sarcoma survivors undergoing amputation or limb salvage. J Clin Oncol. 1985;3:1393–1399.

    PubMed  Google Scholar 

  33. Wood-Dauphinee SL, Opzoomer MA, Williams JI, Marchand B, Spitzer WO. Assessment of global function: The Reintegration to Normal Living Index. Arch Phys Med Rehabil. 1988;69:583–590.

    PubMed  CAS  Google Scholar 

  34. Zahlten-Hinguranage A, Bernd L, Ewerbeck V, Sabo D. Equal quality of life after limb-sparing or ablative surgery for lower extremity sarcomas. Br J Cancer. 2004;91:1012–1014.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, University of Texas Health Science Center San Antonio, Cancer Therapy and Research Center, San Antonio, TX, 78229, USA

    Farbod Malek MD, Jeremy S. Somerson MD, Shannon Mitchel MD & Ronald P. Williams MD

Authors
  1. Farbod Malek MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeremy S. Somerson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shannon Mitchel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ronald P. Williams MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeremy S. Somerson MD.

Additional information

Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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.

About this article

Cite this article

Malek, F., Somerson, J.S., Mitchel, S. et al. Does Limb-salvage Surgery Offer Patients Better Quality of Life and Functional Capacity than Amputation?. Clin Orthop Relat Res 470, 2000–2006 (2012). https://doi.org/10.1007/s11999-012-2271-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-012-2271-1

Keywords

Search

Navigation