Patients Regularly Return to Medium- and Low-Impact Types of Sporting Activities Following Distal Femoral or Proximal Tibial Replacement After Resection of a Primary Bone Sarcoma.

Abstract

Background: Little is known about the resumption of sporting activities following megaprosthetic reconstruction of the distal femur and proximal tibia after resection of a bone sarcoma. Thus, the aims of our study were: (1) to assess the functional outcome; (2) to evaluate pre- and post-operatively performed sporting activities; and (3) to identify potential beneficial and limiting factors.

Methods: Between 1993 and 2015, a total of 230 patients underwent distal femoral replacement (DFR), and 96 patients underwent proximal tibial replacement (PTR). The exclusion criteria were death, amputation, living overseas, and a congenital disability. Functional outcome and sporting activities were assessed using the Musculoskeletal Tumor Society Score (MSTS), Toronto Extremity Salvage Score (TESS), Forgotten Joint Score (FJS), subjective knee value (SKV), the Tegner activity score (TS), and the modified weighted activity score (WAS).

Results: There were 93 patients who had a median follow-up of 182 months (interquartile range (IQR) 130 to 260) after DFR with the following median scores: MSTS 18 (IQR 12 to 23), TESS 75% (IQR 60 to 84), FJS 25 (IQR 8 to 40), SKV 53% (IQR 40 to 70), TS 3 (IQR 3 to 4), and WAS 4 (IQR 0 to 8). There were 42 patients who had a median follow-up of 193 months (IQR 137 to 244) after PTR had the following median scores: MSTS 17 (IQR 15 to 22), TESS 78% (IQR 68 to 88), FJS 32 (IQR 20 to 46), SKV 60% (IQR 40 to 70), TS 3 (IQR 3 to 4), and WAS 4 (IQR 1 to 10). Postoperatively, 61% of DFR and 76% of PTR patients participated in at least one sporting activity.

Conclusions: The functional outcome is overall good with a regular resumption of sporting activities. Patients' age at surgery and higher preoperative sporting levels were associated with better functional outcomes and higher postoperative sporting activity.