Principles of Rehabilitation after Limb-sparing Surgery for Cancer

  • Riki Oren
  • Alice Zagury
  • Orit Katzir
  • Yehuda Kollender
  • Isaac Meller


Until around 1970 amputation was the principal operation performed for bone and soft-tissue sarcomas of the extremities, shoulder, and pelvic girdle. Today 85% of these tumors are treated by limb-sparing surgery (LSS), a procedure that involves reconstruction of bones, joints, and soft tissues using endoprostheses, allografts, autografts, and composites. With proper evaluation and surgical management about 60% of these patients are cured of their underlying disease.

This progress creates new opportunities for rehabilitation medicine. The purpose of this chapter is to describe major considerations associated with the rehabilitative care of patients who have undergone LSS. Specific information on surgery, principles of rehabilitation, and incidence of complications is presented for LSS surgery of the distal femur and knee joint, proximal femur and knee joint, proximal humerus and glenohumeral joint, proximal femur and hip joint, and pelvic girdle. The chapter concludes with information on LSS in children and its role in palliative care.


Proximal Femur Patellar Tendon Distal Femur Proximal Humerus Extensor Mechanism 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Lampert MH, Sugarbaker PH. Rehabilitation ofpatients with extremity sarcoma. In: Sugarbaker PH, Malawer MM, editors. Musculoskeletal Surgery for Cancer. New York: Thieme; 1992:55–73.Google Scholar
  2. 2.
    Lewis MM. Musculoskeletal oncology: a multidisciplinary approach. In: Ragnarsson KT, editor. Rehabilitation of Patients with Physical Disabilities Caused by Tumors of the Musculoskeletal System. Philadelphia: WB Saunders; 1992:429–48.Google Scholar
  3. 3.
    Bunting RW. Rehabilitation of cancer patients with skeletal metastases. Clin Orthop Rel Res. 1995;312:197–200.Google Scholar
  4. 4.
    Rashleigh L. Physiotherapy in palliative oncology. Austr Physiother. 1996;42:307–12.Google Scholar
  5. 5.
    Frieden RA, Ryniker D, Kenan S et al. Assessment of patient function after limb-sparing surgery. Arch Phys Med Rehabil. 1993;74:38–43.PubMedGoogle Scholar
  6. 6.
    Eiser C, Cool P, Grimer RG et al. Quality of life in children following treatment for a malignant primary bone tumor around the knee. Sarcoma. 1997;1:39–45.Google Scholar
  7. 7.
    Rougraff BT, Simon MA, Kneisl JS et al. Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. J Bone Joint Surg. 1994;76-A:649–55.Google Scholar
  8. 8.
    Otis JC, Lane JM, Kroll MA et al. Energy cost during gait in osteosarcoma patients after resection and knee replacement and after above-the-knee amputation. Bone Joint Surg. 1985;67-A:606–10.Google Scholar
  9. 9.
    Hunter G. Specific soft-tissue mobilization in the treatment of soft tissue lesion. Physiotherapy. 1994;80:15–21.Google Scholar
  10. 10.
    Tribe K. Treatment of lymphedema: the central importance of manual lymph drainage. Physiotherapy. 1995;81:154–6.Google Scholar
  11. 11.
    Eckardt JJ, Springfield D, Peabody TD. Distal femur. In: Simon MA, Springfield D, editors. Surgery for Bone and Soft Tissue Tumors. Philadelphia: Lippincott-Raven; 1998:357–73.Google Scholar
  12. 12.
    Markhede G, Stener B. Function after removal of various hip and thigh muscles for extirpation of tumor. Acta Orthop Scand. 1981;52:373–95.PubMedGoogle Scholar
  13. 13.
    Tsuboyama T, Windhager R, Dock W et al. Knee function after operation for malignancy of the distal femur. Acta Orthop Scand. 1993;64:673–7.PubMedGoogle Scholar
  14. 14.
    Gebhardt MC, Springfield D, Eckardt JJ. Tibia. In: Simon MA, Springfield D, editors. Surgery for Bone and Soft Tissue Tumors. Philadelphia: Lippincott-Raven;1998:375–91.Google Scholar
  15. 15.
    Malawer MM, Mchale KA. Limb-sparing surgery for high-grade malignant tumors of the proximal tibia. Clin Orthop Rel Res. 1989;239:231–48.Google Scholar
  16. 16.
    Petschnig R, Baron R, Kotz R. Muscle function after endoprosthetic replacement of the proximal tibia. Acta Orthop Scand. 1995;66:266–77.PubMedGoogle Scholar
  17. 17.
    Darmon T, Rock MG, O’Connor MI et al. Distal upper extremity function following proximal humeral resection and reconstruction for tumors: contralateral comparison. Ann Surg Oncol. 1997;4:237–46.Google Scholar
  18. 18.
    Eckardt JJ, Springfield D, Malawer MM. Hip and proximal femur. In: Simon MA, Springfield D, editors. Surgery for Bone and Soft-Tissue Tumors. Philadelphia: Lippincott-Raven; 1998:343–55.Google Scholar
  19. 19.
    Gose JC, Schweizer P. Iliotibial band tightness. J Sports Med Phys Ther. 1989;10:399–40.Google Scholar
  20. 20.
    Conrad EU, Springfield D, Peabody TD. Pelvis. In: Simon MA, Springfield D, editors. Surgery for Bone and Soft Tissue Tumors. Philadelphia: Lippincott-Raven; 1998:323–41.Google Scholar
  21. 21.
    Fulton CL. Physiotherapists in cancer care: a framework for rehabilitation of patients. Physiotherapy. 1994;80: 830–4.Google Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Riki Oren
  • Alice Zagury
  • Orit Katzir
  • Yehuda Kollender
  • Isaac Meller

There are no affiliations available

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