title: Can orthopedic oncologists predict functional outcome in patients with sarcoma after limb salvage surgery in the lower limb? A nationwide study.
abstract: Accurate predictions of functional outcome after limb salvage surgery (LSS) in the lower limb are important for several reasons, including informing the patient preoperatively and, in some cases, deciding between amputation and LSS. This study aimed to elucidate the correlation between surgeon-predicted and patient-reported functional outcome of LSS in the Netherlands. Twenty-three patients (between six months and ten years after surgery) and five independent orthopedic oncologists completed the Toronto Extremity Salvage Score (TESS) and the RAND-36 physical functioning subscale (RAND-36 PFS). The orthopedic oncologists made their predictions based on case descriptions (including MRI scans) that reflected the preoperative status. The correlation between patient-reported and surgeon-predicted functional outcome was "very poor" to "poor" on both scores (r (2) values ranged from 0.014 to 0.354). Patient-reported functional outcome was generally underestimated, by 8.7% on the TESS and 8.3% on the RAND-36 PFS. The most difficult and least difficult tasks on the RAND-36 PFS were also the most difficult and least difficult to predict, respectively. Most questions had a "poor" intersurgeon agreement. It was difficult to accurately predict the patient-reported functional outcome of LSS. Surgeons' ability to predict functional scores can be improved the most by focusing on accurately predicting more demanding tasks.
authors.affiliation: Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Kolk
authors.affiliation: Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Kevin
authors.initials: K
authors.lastname: Cox
authors.affiliation: Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands ; Sint Maartenskliniek Research, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands.
authors.forename: Vivian
authors.initials: V
authors.lastname: Weerdesteyn
authors.affiliation: Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Gerjon
authors.initials: G
authors.lastname: Hannink
authors.affiliation: Department of Orthopaedic Surgery, Amsterdam University Medical Centre, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: Bramer
authors.affiliation: Department of Orthopaedic Surgery, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Sander
authors.initials: S
authors.lastname: Dijkstra
authors.affiliation: Department of Orthopaedic Surgery, Groningen University Medical Centre, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Jutte
authors.affiliation: Department of Orthopaedic Surgery, Groningen University Medical Centre, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
authors.forename: Joris
authors.initials: J
authors.lastname: Ploegmakers
authors.affiliation: Department of Orthopaedic Surgery, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Michiel
authors.initials: M
authors.lastname: van de Sande
authors.affiliation: Department of Orthopaedic Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Schreuder
authors.affiliation: Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands ; Laboratory for Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
authors.forename: Nico
authors.initials: N
authors.lastname: Verdonschot
authors.affiliation: Department of Orthopaedic Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Ingrid
authors.initials: I
authors.lastname: van der Geest