Does limb-salvage surgery offer patients better quality of life and functional capacity than amputation?
BACKGROUND
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.


OBJECTIVE
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.


CONCLUSIONS
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.
Department of Orthopaedics, University of Texas Health Science Center San Antonio, Cancer Therapy and Research Center, San Antonio, TX 78229, USA.
Farbod
F
Malek
Jeremy S
JS
Somerson
Shannon
S
Mitchel
Ronald P
RP
Williams
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects / Q000523:psychology; D000674:Amputees / Q000523:psychology*; D001186:Artificial Limbs; D001859:Bone Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D005260:Female; D006801:Humans; D023821:Limb Salvage / Q000009:adverse effects / Q000523:psychology; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010465:Perception; D017755:Prosthesis Fitting; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D011795:Surveys and Questionnaires; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult