Does Limb-salvage Surgery Offer Patients Better Quality of Life and Functional Capacity than Amputation?

Farbod Malek MD, Jeremy S. Somerson MD, Shannon Mitchel MD, Ronald P. Williams MD
Clinical Research
Online First ™ - February , 2012

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Abstract

Introduction

Patients with aggressive lower extremity musculoskeletal tumors may be candidates for either above-knee amputation or limb-salvage surgery. However, the subjective and objective benefits of limb-salvage surgery compared with amputation are not fully clear.

Questions/Purposes

We therefore compared functional status and quality of life for patients treated with above-knee amputation versus limb-salvage surgery.

Methods

We reviewed 20 of 51 patients aged 15 years and older treated with above-knee amputation or limb-salvage surgery for aggressive musculoskeletal tumors around the knee between 1994 and 2004 as a retrospective cohort study. At last followup we obtained the Physiological Cost Index, the Reintegration to Normal Living Index, SF-36, and the Toronto Extremity Salvage Score questionnaires. The minimum followup was 12 months (median, 56 months; range, 12–108 months).

Results

Compared with patients having above-knee amputation, patients undergoing limb-salvage surgery had superior Physiological Cost Index scores and Reintegration to Normal Living Index. The Toronto Extremity Salvage scores and SF-36 scores were similar in the two groups.

Conclusion

These data suggest that limb-salvage surgery offers better gait efficiency and return to normal living compared with above-knee amputation, but does not improve the patient’s perception of quality of life.

Level of Evidence

Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.