EVALUATION OF THE EFFECTIVENESS OF FUNCTIONALLY DIRECTED PHYSICAL THERAPY IN PATIENTS AFTER ONCOLOGICAL KNEE ARTHROPLASTY
DOI:
https://doi.org/10.32782/pub.health.2025.2.3Keywords:
physical therapy, oncological rehabilitation, joint endoprosthesis, gait disturbance, lower limbAbstract
Topicality. Modern onco-orthopedics uses modular endoprostheses as a method of reconstruction in tumor resections in the knee joint. Despite advances in surgical technologies, restoration of motor functions in such patients remainsdifficult due to the volume of resection, concomitant soft tissue damage, the need for adjuvant therapy, and the high riskof complications. Unlike standard knee arthroplasty, in the case of oncological interventions, the results of rehabilitation are less predictable, which justifies the need to develop specialized physical therapy programs. Objective. To assess the effectiveness of a functionally directed physical therapy program in patients after oncological knee arthroplasty accordingto indicators of functional status and multifactorial quality of life. Materials and methods. The study included 7 patients(4 men and 3 women) aged 25–52 years (mean age 37.0 ± 3.2) who underwent knee arthroplasty for osteosarcoma. Thephysical therapy program lasted 12 weeks and included a mandatory block of muscle strengthening exercises, balanceand gait training, and a variable block of individually directed functional tasks. The patients’ condition was assessedusing the MSTS (Musculoskeletal Tumor Society) scale and the FACT-G (Functional Assessment of Cancer Therapy – General) questionnaire. Research results. After completing the physical therapy program, a significant improvement in all indicators was noted (p < 0.05). According to the MSTS scale, the greatest increase was noted in the areas of “Support/ Walking” (an increase of 147.6%), “Function” (98.2%), and “Pain” (84.3%), which indicates a significant restorationof motor autonomy and a decrease in pain syndrome. The total score increased from 44.2 to 75.9, which corresponds to the transition from a satisfactory to a good level of functioning. According to the FACT-G scale, the indicators of physical (51.4%) and functional (50.9%) well-being improved the most, while the emotional and social domains increased by31.0% and 19.4%, respectively. The total score increased from 66.64 ± 1.12 to 84.71 ± 1.14, which confirms the positivesystemic impact of the program. Conclusions. The developed functionally directed physical therapy program in patientsafter oncological knee arthroplasty is effective for restoring motor function, reducing pain, and improving multifactorialquality of life. The results obtained indicate the feasibility of integrating such programs into clinical rehabilitation routes for onco-orthopedic patients.
References
Ebeid W.A., Abo-Senna W.G., Hasan B.Z., Badr I.T., Mesregah M.K. Functional and oncological outcomes of limb-salvage surgery for foot and ankle tumors. Foot (Edinb). 2019. No. 41. Р. 34–38. https://doi.org/10.1016/j.foot.2019.06.007.
Gazendam A.M., Schneider P., Heels-Ansdell D., Bhandari M., Busse J.W., Ghert M. Predictors of Functional Recovery among Musculoskeletal Oncology Patients Undergoing Lower Extremity Endoprosthetic Reconstruction. Curr Oncol. 2022. Vol. 29 (10). Р. 7598–7606. https://doi.org/10.3390/curroncol29100600.
Gosheger G., Gebert C., Ahrens H., Streitbuerger A., Winkelmann W., Hardes J. Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res. 2006. No. 450. Р. 164–171. https://doi.org/10.1097/01.blo.0000223978.36831.39.
Aravitska M., Saienko O. The influence of physical therapy on indicators of locomotive syndrome in elderly persons with osteoarthritis of the knee and obesity. Clinical and Preventive Medicine. 2023. No. 4. Р. 6–13. https://doi.org/10.31612/2616-4868.4(26).2023.01.
Tunn P.U., Pomraenke D., Goerling U., Hohenberger P. Functional outcome after endoprosthetic limb-salvage therapy of primary bone tumours--a comparative analysis using the MSTS score, the TESS and the RNL index. Int Orthop. 2008. Vol. 32 (5). Р. 619–625. https://doi.org/10.1007/s00264-007-0388-8.
Enneking W.F., Dunham W., Gebhardt M.C., Malawar M., Pritchard D.J. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993. No. 286. Р. 241–246.
Cella D.F., Tulsky D.S., Gray G, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993. Vol. 11 (3). Р. 570-579. https://doi.org/10.1200/JCO.1993.11.3.570.
Grimer R.J., Taminiau A.M., Cannon S.R. Surgical Subcommitte of the European Osteosarcoma Intergroup. Surgical outcomes in osteosarcoma. J Bone Joint Surg Br. 2002. Vol. 84 (3). Р. 395–400. https://doi.org/10.1302/0301-620x.84b3.12019.
Furtado S., Errington L., Godfrey A., Rochester L., Gerrand C. Objective clinical measurement of physical functioning after treatment for lower extremity sarcoma – A systematic review. Eur J Surg Oncol. 2017. Vol. 43 (6). Р. 968–993. https://doi.org/10.1016/j.ejso.2016.10.002.
Speck R.M., Courneya K.S., Mâsse L.C., Duval S., Schmitz K.H. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv. 2010. Vol. 4 (2). Р. 87–100. https://doi.org/10.1007/s11764-009-0110-5.
Saebye C., Amidi A., Keller J., Andersen H., Baad-Hansen T. Changes in Functional Outcome and Quality of Life in Soft Tissue Sarcoma Patients within the First Year after Surgery: A Prospective Observational Study. Cancers (Basel). 2020. Vol. 12 (2). Р. 463. https://doi.org/10.3390/cancers12020463.
