title: Standardization of rehabilitation after limb salvage surgery for sarcomas improves patients' outcome.
abstract: OBJECTIVE
  The purpose of this study is to establish a standardized postoperative rehabilitation protocol following limb salvage surgery (LSS) in patients with primary bone sarcoma in five major anatomical locations: distal femur, proximal tibia, proximal and total femur, humerus and shoulder girdle and pelvic resections.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  All LSSs were performed by an orthopedic oncology surgeon, and rehabilitation of all patients was based on a devised standardized rehabilitation protocol. Patient outcomes were measured using the modified Musculoskeletal Tumor Society-International Symposium on the Limb Salvage (MSTS-ISOLS) scoring system.
  
  
  RESULTS
  A total of 59 patients received LSS in the above mentioned locations; endoprostheses were used in 49, bone allograft in five, while no replacements were made in five patients. At a mean follow-up of 24 months, the mean modified MSTS-ISOLS score for all patients was 87% (95% CI; 0.85-0.89). The highest scores were encountered for patients with distal femur replacement: 93% (95% CI; 0.91-0.95). Seven patients had interruption of more than six weeks in their rehabilitation and had a mean score of 71% (95% CI; 0.64-0.82).
  
  
  CONCLUSIONS
  The proposed rehabilitation protocol is a comprehensive, organized and applicable guideline to be used after performing LSS at the above mentioned anatomical locations. The use of standardized rehabilitation protocol resulted in improved patient functional outcome.
authors.affiliation: Section of Orthopedic Oncology, King Hussein Cancer Center, Amman, Jordan. Electronic address: ashehadeh@khcc.jo.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Shehadeh
authors.forename: Mostafa
authors.initials: M
authors.lastname: El Dahleh
authors.forename: Ahmed
authors.initials: A
authors.lastname: Salem
authors.forename: Yousef
authors.initials: Y
authors.lastname: Sarhan
authors.forename: Iyad
authors.initials: I
authors.lastname: Sultan
authors.forename: Robert M
authors.initials: RM
authors.lastname: Henshaw
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Aboulafia
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D006811:Humerus / Q000601:surgery; D023821:Limb Salvage / Q000534:rehabilitation* / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000601:surgery; D012015:Reference Standards; D012509:Sarcoma / Q000534:rehabilitation* / Q000601:surgery*; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Limb salvage surgery; Protocol; Rehabilitation; Sarcoma