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What sports activity levels can be achieved in the long-term after major lower extremity amputation for malignant tumors? – A minimum follow-up of twenty years - 13/05/22

Doi : 10.1016/j.otsr.2022.103229 
Christoph Hofer a, Carmen Trost a, Kevin Döring a, Tryphon Kelaridis b, Reinhard Windhager a, Gerhard M. Hobusch a,
a Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria 
b Ordination Dr. Kelaridis and Partner, Vienna, Austria 

Corresponding author. Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna General Hospital, Währinger Gürtel 18-20, 1090 Wien, Austria.Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna General HospitalWähringer Gürtel 18-20Wien1090Austria
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 13 May 2022

Abstract

Background

It is well-known that exercise through sports and physical activity has beneficial effects on health. After lower extremity amputation, low rates of participation in sports activities have been shown. So far, there is only limited scientific long-term information concerning sports activity and feasible types of sports in patients with lower extremity amputations due to malignant tumors. This study sought to provide very long-term information about the following questions: (1) What sports activity levels can be achieved after lower extremity amputation due to a malignant tumor? (2) What are feasible types of sports? (3) Is the University of California Los Angeles (UCLA) Activity Score influenced by patient's age, the age at the time of surgery and the amount of prosthesis sockets used to date?

Hypothesis

Patients with lower extremity amputation due to a malignant tumor cannot regularly participate in moderate sports activities (UCLA Activity Score6) in the very long-term.

Materials and methods

In a retrospective questionnaire survey, 21 former patients (seven females, 14 males; median age: 60.5years [range: 33–74]) who underwent an amputation of the lower extremity (14 transfemoral, four knee disarticulations, three transtibial) from 1961 to 1993 due to a malignant tumor were interviewed. The median follow-up was 41.1years (range: 23–55). The patients were interviewed about types of sports, frequencies and durations of sports sessions at the time of the last follow-up, as well as retrospectively. Sports activity levels were then assessed based on the UCLA Activity Score. Demographic background, data on amputation level, histological results, prosthetic devices and revision surgeries were collected.

Results

Seven patients (33%) were still regularly exercising at least moderate sports activities at the last follow-up, including one patient regularly participating in impact sports. The preoperative median UCLA Activity Score of 9 (range: 2–10) decreased to 5 (range: 2–10) at the last follow-up (p<0.001). Swimming (13 patients, seven on a regular basis), cycling (seven), downhill skiing (five) and hiking (four) were among the most common feasible types of sports. Increasing age had a negative influence on the UCLA Activity Score [95% CI (−0.034, −0.006); RB=−0.020; SD=0.0074; p=0.007].

Conclusion

After a major amputation in the lower extremity due to a malignant tumor, high activity levels by practicing types of sports such as downhill skiing, are achievable. In the very long-term, a regular participation in at least moderate activities, such as swimming, is possible. Programs for physical and sports activities, based on recommendations drawn from long-term experience, are necessary and should be individually tailored to amputees and their limitations.

Level of evidence

IV.

Le texte complet de cet article est disponible en PDF.

Keywords : Sport, Lower extremity amputation, Malignant bone tumors


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© 2022  Publié par Elsevier Masson SAS.
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