Functional outcome in amputation versus limb sparing of patients with lower extremity sarcoma: a matched case-control study

Arch Phys Med Rehabil. 1999 Jun;80(6):615-8. doi: 10.1016/s0003-9993(99)90161-2.


Objective: To quantify the differences in physical disability and handicap experienced by patients with lower extremity sarcoma who required amputation for their primary tumor as compared with those treated by limb-sparing surgery.

Design: Matched case-control study. Twelve patients with amputation were matched with 24 patients treated by limb-sparing surgery on the following variables: age, gender, length of follow-up, bone versus soft-tissue tumor, anatomic site, and treatment with adjuvant chemotherapy.

Patients: Patients who underwent above-knee amputation (AKA) or below-knee amputation (BKA) for primary soft-tissue or bone sarcoma, who had not developed local or systemic recurrence, and who had been followed up for at least 1 year since surgery.

Main outcome measures: The Toronto Extremity Salvage Score (TESS), a measure of physical disability; the Shortform-36 (SF-36), a generic health status measure; and the Reintegration to Normal Living (RNL), a measure of handicap.

Results: Mean TESS score for the patients with amputations was 74.5 versus 85.1 for the limb-sparing patients. (p = .15). Only the physical function subscale of the SF-36 showed statistically significant differences, with means of 45 and 71.1 for the amputation versus limb-sparing groups, respectively (p = .03). The RNL for the amputation group was 84.4 versus 97 for the limb-sparing group (p = .05). Seven of the 12 patients with amputations experienced ongoing difficulty with the soft tissues overlying their stumps.

Conclusions: There was a trend toward increased disability for those in the amputation group versus those in the limb-sparing group, with the amputation group showing significantly higher levels of handicap. These data suggest that the differences in disability between amputation and limb-sparing patients are smaller than anticipated. The differences may be more notable in measuring handicap.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adult
  • Amputation, Surgical*
  • Bone Neoplasms / rehabilitation
  • Bone Neoplasms / surgery*
  • Case-Control Studies
  • Disabled Persons
  • Female
  • Follow-Up Studies
  • Humans
  • Leg / surgery*
  • Male
  • Methods
  • Osteosarcoma / surgery
  • Sarcoma / rehabilitation
  • Sarcoma / surgery*
  • Soft Tissue Neoplasms / rehabilitation
  • Soft Tissue Neoplasms / surgery*
  • Time Factors
  • Treatment Outcome