When Your Ankle Becomes a Knee – Long-Term Functional Outcome and Quality of Life with a Rotationplasty after Resection of Malignant Limb Tumors

Abstract

Background Increasing numbers of patients surviving malignant bone tumors around the knee joint have led to an increasing importance to investigate long-term results. This study assessed the long-term results of rotationplasty after resection of malignant bone tumors regarding functional outcome and quality of life to allow better comparison with other treatment options in bone cancer treatment.

Procedure 60 participants who underwent rotationplasty due to bone cancer took part in this multicentric questionnaire-based study. The long-term functional outcome was measured by the Musculoskeletal tumor society score (MSTS) and the Tegner activity level scale. The health-related quality of life (HRQL) was assessed by using the Short Form Health Survey (SF-36).

Results Patients treated with rotationplasty (median follow-up of 22 years, range 10–47 years) regained a high level of activity (median MSTS score of 24). Even a return to high level sports was possible (mean Tegner activity level scale of 4). Duration of follow-up did not influence the functional outcome. HRQL scores were comparable to the general German population. Concerns of psychological problems due to the unusual appearance of the rotated foot have not been confirmed.

Conclusion Rotationplasty can be a good alternative to endoprosthetic replacement or amputation, either as primary surgery or as a salvage procedure. Especially for growing children and very active patients rotationplasty should be considered.

Zusammenfassung

Hintergrund Durch die steigenden Überlebensraten von Patienten, die maligne Knochentumore im Bereich des Kniegelenks überleben, wird es immer wichtiger, die Langzeitergebnisse dieser Patienten zu untersuchen. In dieser Studie wurden die Langzeitergebnisse der Borggreve-Umkehrplastik nach Resektion maligner Knochentumore im Hinblick auf das funktionelle Ergebnis und die Lebensqualität untersucht, um einen besseren Vergleich mit anderen Behandlungsoptionen in der Knochenkrebsbehandlung zu ermöglichen.

Methoden 60 Teilnehmer, die sich aufgrund eines Knochentumors einer Borggreve-Umkehrplastik unterzogen, nahmen an dieser multizentrischen Studie teil. Das langfristige funktionelle Ergebnis wurde mit dem Musculoskeletal Tumor Society Score (MSTS) und der Tegner-Aktivitätsskala erfasst. Die gesundheitsbezogene Lebensqualität (HRQL) wurde mit Hilfe des Short Form Health Surveys (SF-36) ermittelt.

Ergebnisse Die befragten Patienten (mediane Nachbeobachtungszeit von 22 Jahren, Spanne 10–47 Jahre) erlangten ein hohes Aktivitätsniveau zurück (medianer MSTS-Score von 24). Selbst eine Rückkehr zum Leistungssport war möglich (mittlere Tegner-Aktivitätsskala von 4). Die Dauer der Nachbeobachtung hatte keinen Einfluss auf das funktionelle Ergebnis. In Bezug auf die gesundheitsbezogene Lebenszufriedenheit (HRQL) zeigten sich vergleichbare Ergebnisse zur allgemeinen deutschen Bevölkerung. Die Befürchtungen von psychologischen Problemen aufgrund des ungewöhnlichen Aussehens des gedrehten Fußes haben sich nicht bestätigt.

Schlussfolgerungen Die Borggreve-Umkehrplastik kann eine gute Alternative zum endoprothetischen Ersatz oder zur Amputation sein, nicht nur als Primäreingriff, sondern auch als Sekundäreingriff nach Versagen des endoprothetischen Ersatzes. Insbesondere bei Kindern im Wachstumsalter und bei sehr aktiven Patienten sollte die Borggreveplastik in Betracht gezogen werden.

Key words

quality of life - functional outcome - long-term outcome - bone cancer - rotationplasty

Schlüsselwörter

Knochentumor - Borggreve-Umkehrplastik - Lebenszufriedenheit - Langzeitergebnisse

Publication History

Article published online:
13 December 2021

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