The functional recovery trajectory in patients undergoing lower limb salvage surgery for bone tumour: an...

The aim of this study was to describe functional outcomes during the first 6 months after surgery, providing an overview of the recovery trajectory based on tumour anatomical location.

A retrospective observational cohort study was conducted. All patients who underwent lower limb resection and reconstruction between January 2019 and December 2023 and received postoperative rehabilitation were consecutively enrolled. Postoperative complications, walking recovery, and climbing three steps were assessed early after surgery. Joint range of motion, muscle strength, timed up and go test, 6-min walking test, and Toronto Extremity Salvage Score were collected at 3 and 6 months of follow-up. The outcomes achieved by the patients were stratified based on the anatomical location of the reconstruction.

A total of 92 patients were included. Patients with pelvic, proximal femoral, and proximal tibial reconstructions had a markedly higher likelihood of failing to perform early stair climbing compared with those with distal femur reconstruction, which showed the best early functional outcomes (non-execution rates: 87%, 75%, and 85%, respectively). A similar pattern was observed at 3 months for joint mobility, muscle strength, and motor performance. By the second follow-up, these differences tended to diminish, particularly for proximal femoral and proximal tibial reconstructions, whereas pelvic reconstruction consistently remained associated with the slowest recovery. Despite this improvement, muscle strength recovery continued to be significantly lower in these groups (p = 0.021). Autonomy recovery analysis confirmed this gradient, showing a 22.9-point deficit (95% CI -46.5 to -0.6) in patients with pelvic reconstruction.

Compared with patients undergoing distal femur reconstruction, those undergoing pelvic reconstruction showed slower and less satisfactory functional recovery, whereas patients with proximal femur and proximal tibia reconstructions experienced delayed but progressive improvement. Recovery trajectories differ according to anatomical site, and these findings provide practical reference points to guide individualised physiotherapy planning and set realistic location-specific rehabilitation goals.

The study has been registered in the clinicaltrial.gov database with number NCT06376539 (first submitted 15/04/2024).