Abstract
Introduction
As survival rates associated with the multimodal treatment of malignant bone cancer
(osteosarcoma and Ewing’s sarcoma) are satisfactory, health-related quality of life
and the return to
activity and sports by the affected patients have attracted increasing attention in
recent years. Nowadays, limbs can be salvaged for most patients using modular endoprostheses.
Such
patients are typically adolescents and young adults who have high activity levels
and thereby high demands for multimodal cancer treatment. This study aimed to evaluate
the activity levels
and sporting proficiencies that can be attained after modular endoprosthetic treatment
of bone sarcomas as well as the extent to which physiotherapeutic and sports interventions
influence
functional outcome and activity levels.
Methods
This non-systematic review of the literature focused on the return to activity and
sports after modular endoprosthetic treatment of lower extremities bone sarcomas in
adolescents and
young adults. The electronic database PubMed was screened for relevant publications
on this issue. A treatment algorithm for return to activity and sports in tumor orthopaedics
is
proposed.
Results and Discussion
The objective activity level (gait cycles per day and gait intensities) in patients
treated for bone sarcomas is reduced in short- and long-term follow-ups compared with
healthy controls
and patients with other cancers (leukaemia). Although a negative impact is observed
in terms of motor performance, it shows improvement over time. Functional assessment
at 12 postoperative
months is sensible as neoadjuvant chemotherapy is completed by then. In long-term
follow-up, patients with bone sarcomas can achieve high sports activity levels, i.e.,
type of sport,
frequency/week and UCLA score, after modular endoprosthetic reconstruction. The maximum
level is attained at 5 years postoperatively. Nevertheless, there is a shift from
high- and
intermediate- to low-impact sports. Only 20% of the patients participate in school
sports regularly without limitations. The localisation of bone sarcoma, but not the
rate of postoperative
complications, influences the postoperative activity level. Individualised sports-related
interventions during and after multimodal treatment can improve the short-term activity
levels;
moreover, “serious games” can improve motor performance and postural control. There
is no evidence that intense activity levels leads to early loosening of the endoprosthesis.
There is
insufficient valid data on activity and sports after modular endoprosthetic treatment
of bone sarcomas of the upper extremities.
Conclusion
High preoperative activity levels of young patients with bone sarcomas must be considered
in tumour orthopaedics. Limitations on sports activities have a significant negative
impact on
the quality of life and mental health of such patients. Therefore, tumour orthopaedic
treatment has to focus on preserving an improvement in these factors. The overall
existing evidence
concerning this issue is weak. Additional studies to evaluate the ability to return
to specific sports activities are desirable, as well as prospective interventional
studies.
Keywords
bone cancer - tumor orthopedics - return to activity - sports - intervention
