title: Do patients with ewing's sarcoma continue with sports activities after limb salvage surgery of the lower extremity?
abstract: BACKGROUND
  Limb salvage surgery has evolved to become the standard method of treating sarcomas of the extremities with acceptable oncologic results. However, little information exists relative to the activity level or ability to participate in sports after tumor reconstructions.
  
  
  OBJECTIVE
  The aims of the study were to answer the following questions: (1) Which sports activity levels and what types of sports can be expected in the long term after tumor reconstruction? (2) Which frequency durations are patients with Ewing's sarcoma able to perform in long-term followup after local control? (3) Do surgical complications affect sports activity level?
  
  
  METHODS
  Thirty patients (13 females, 17 males; mean age, 18 ± 8 years; range, 2-36 years at diagnosis; mean followup 16 ± 6 years [minimum, 5 years]) were included. Tumors were located in the pelvis, femur, tibia, and fibula. Surgical procedures included surgical resections alone (n = 8), surgical resection with biological reconstruction (n = 9), or endoprosthetic reconstruction (n = 13). We assessed UCLA sports activity levels, kinds of sports as well as the frequency per week and the duration of each training unit at long term (minimum followup, 5 years).
  
  
  RESULTS
  In long-term followup 83% patients (25 of 30) were performing athletic activity regularly. The hours/week of sports depended on type of surgery and were highest after resections in the pelvis and femur (5.8) and were lowest after megaprosthetic reconstruction of the pelvis (1.0). Patients undergoing biologic reconstructions were able to perform high-impact sports. UCLA sports activity levels were high after joint-preserving vascularized fibula for tibia reconstruction (7.4) and after megaprosthetic reconstruction of the lower extremity (6.3-6.4) and were low after tumors located in the fibula (4.2). Complications during followup did not significantly influence sports activity in long-term survivors.
  
  
  CONCLUSIONS
  Long-term survivors can achieve high levels of sports activity in many instances. Tumor sites are associated with the postoperative sports activity levels. This information can help surgeons counsel patients in terms of athletic expectations after limb salvage reconstruction for patients with Ewing's sarcoma.
  
  
  METHODS
  Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria, gerhard.hobusch@meduniwien.ac.at.
authors.forename: Gerhard Martin
authors.initials: GM
authors.lastname: Hobusch
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Lang
authors.forename: Reinhard
authors.initials: R
authors.lastname: Schuh
authors.forename: Reinhard
authors.initials: R
authors.lastname: Windhager
authors.forename: Jochen Gerhard
authors.initials: JG
authors.lastname: Hofstaetter
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D023821:Limb Salvage; D035002:Lower Extremity / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods; D012512:Sarcoma, Ewing / Q000503:physiopathology / Q000601:surgery*; D013177:Sports; D017741:Survivors; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Osteoarthritis Cartilage. 2011 Jun;19(6):620-33
references.pmid: 21251989
references.citation: PLoS One. 2012;7(10):e47944
references.pmid: 23082232
references.citation: Sports Health. 2011 Sep;3(5):441-50
references.pmid: 23016041
references.citation: J Arthroplasty. 1998 Dec;13(8):890-5
references.pmid: 9880181
references.citation: Pediatr Blood Cancer. 2006 Jul;47(1):22-9
references.pmid: 16572419
references.citation: Future Oncol. 2010 Jul;6(7):1155-62
references.pmid: 20624127
references.citation: Br J Cancer. 2008 Jul 8;99(1):30-6
references.pmid: 18577993
references.citation: J Bone Joint Surg Am. 2008 Oct;90(10):2245-52
references.pmid: 18829924
references.citation: J Clin Oncol. 2008 Sep 20;26(27):4385-93
references.pmid: 18802150
references.citation: J Bone Joint Surg Am. 1978 Sep;60(6):731-46
references.pmid: 701308
references.citation: J Surg Oncol. 2003 Jul;83(3):154-60
references.pmid: 12827683
references.citation: Ann Oncol. 2007 Dec;18(12):1957-62
references.pmid: 17804476
references.citation: Clin Orthop Relat Res. 1980 Nov-Dec;(153):106-20
references.pmid: 7449206
references.citation: J Natl Cancer Inst. 2010 Aug 18;102(16):1272-83
references.pmid: 20656964
references.citation: Cancer. 2003 Dec 15;98(12):2687-92
references.pmid: 14669290
references.citation: Am J Prev Med. 2003 Jan;24(1):22-8
references.pmid: 12554020
references.citation: Int J Radiat Oncol Biol Phys. 1995 Jul 15;32(4):919-30
references.pmid: 7607966
references.citation: Klin Padiatr. 1988 May-Jun;200(3):243-52
references.pmid: 3145357
references.citation: Am J Prev Med. 1997 Jul-Aug;13(4):317-23
references.pmid: 9236971
references.citation: Med Sci Sports Exerc. 2011 Jul;43(7):1334-59
references.pmid: 21694556
references.citation: Arch Orthop Trauma Surg. 1999;119(3-4):199-204
references.pmid: 10392519
references.citation: CMAJ. 2001 Jul 24;165(2):174-9
references.pmid: 11501456
references.citation: J Bone Joint Surg Am. 2013 Jan 16;95(2):138-45
references.pmid: 23324961
references.citation: Eur J Cancer. 2009 Jul;45(10):1744-7
references.pmid: 19327986
references.citation: ANZ J Surg. 2005 Jun;75(6):405-8
references.pmid: 15943726
references.citation: Cancer Treat Res. 2009;152:289-308
references.pmid: 20213397
references.citation: J Registry Manag. 2011 Autumn;38(3):153-61
references.pmid: 22223058
references.citation: Int J Radiat Oncol Biol Phys. 2003 Jan 1;55(1):168-77
references.pmid: 12504050
references.citation: Clin Orthop Relat Res. 2009 Apr;467(4):958-65
references.pmid: 18587624
references.citation: J Bone Joint Surg Am. 2011 Mar 2;93(5):418-29
references.pmid: 21368074
references.citation: Mayo Clin Proc. 2012 May;87(5):475-87
references.pmid: 22560526
references.citation: Breast Cancer Res Treat. 2010 Jun;121(2):413-9
references.pmid: 20443054
references.citation: Med Sci Sports Exerc. 2002 Dec;34(12):1863-7
references.pmid: 12471288
references.citation: Clin Orthop Relat Res. 1999 Jan;(358):120-7
references.pmid: 9973983
references.citation: Pediatr Blood Cancer. 2009 Jul;53(1):84-9
references.pmid: 19343771
references.citation: J Bone Joint Surg Br. 1987 Mar;69(2):271-5
references.pmid: 3818759
references.citation: Expert Rev Pharmacoecon Outcomes Res. 2011 Feb;11(1):59-73
references.pmid: 21351859
references.citation: Pediatr Hematol Oncol. 2012 Feb;29(1):1-11
references.pmid: 22295994
references.citation: J Am Acad Orthop Surg. 2003 Jan-Feb;11(1):25-37
references.pmid: 12699369