Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol.

BACKGROUND: We describe a multidisciplinary approach for comprehensive care of amputees with concurrent targeted muscle reinnervation (TMR) at the time of amputation. METHODS: Our TMR cohort was compared to a cross-sectional sample of unselected oncologic amputees not treated at our institution (N = 58). Patient-Reported Outcomes Measurement Information System (NRS, PROMIS) were used to assess postamputation pain. RESULTS: Thirty-one patients underwent amputation with concurrent TMR during the study; 27 patients completed pain surveys; 15 had greater than 1 year follow-up (mean follow-up 14.7 months). Neuroma symptoms occurred significantly less frequently and with less intensity among the TMR cohort. Mean differences for PROMIS pain intensity, behavior, and interference for phantom limb pain (PLP) were 5.855 (95%CI 1.159-10.55; P = .015), 5.896 (95%CI 0.492-11.30; P = .033), and 7.435 (95%CI 1.797-13.07; P = .011) respectively, with lower scores for TMR cohort. For residual limb pain, PROMIS pain intensity, behavior, and interference mean differences were 5.477 (95%CI 0.528-10.42; P = .031), 6.195 (95%CI 0.705-11.69; P = .028), and 6.816 (95%CI 1.438-12.2; P = .014), respectively. Fifty-six percent took opioids before amputation compared to 22% at 1 year postoperatively. CONCLUSIONS: Multidisciplinary care of amputees including concurrent amputation and TMR, multimodal postoperative pain management, amputee-centered rehabilitation, and peer support demonstrates reduced incidence and severity of neuroma and PLP.

Imaging and Clinical Characteristics Predict Near-Term Disablement From Bone Metastases: Implications for Rehabilitation.

OBJECTIVE: To distinguish which patients with bone metastases are at risk for near-term disablement in order to assist clinicians in assessing the appropriateness of referrals for rehabilitation services. DESIGN: Prospective cohort study. SETTING: National Cancer Institute-designated comprehensive cancer center imbedded in a tertiary medical center. PARTICIPANTS: Data were collected from members (n=78) of a patient cohort (N=311) with stage IIIB or IV non-small-cell lung cancer or extensive-stage small-cell lung cancer who developed new or progressive imaging-confirmed bone metastases during the 2-year course of the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional capabilities were assessed at 3- to 4-week intervals over the study's 2-year duration with the Activity Measure for Post-Acute Care Computer Adaptive Testing. RESULTS: Seventy-eight participants developed new or progressive bone metastases during the study. Most were men, and 83% had non-small-cell lung cancer. Metastases were most frequently located in the ribs (n=62), pelvis (n=49), or the thoracic (n=60) and lumbar spine (n=44). While neither the number of bone metastases nor their specific location was associated with near-term changes in patient mobility, their association with pain or a focal neurologic deficit was strongly associated with large declines in mobility. Similarly, patients whose imaging studies revealed new metastases and the expansion of established metastases were more likely to lose mobility. CONCLUSIONS: The total burden, specific locations, and overall distribution of bone metastases did not predict disablement. Patients with lung cancer-associated bone metastases are at markedly increased risk for declining mobility when their metastases are expanding in size and increasing in number, or are associated with pain or with new neurologic deficits.

[Psychomotricity and bone tumors in children]. / Psychomotricité et tumeurs osseuses de l'enfant.

Psychomotricity therapists work with patients following a medical prescription, for prevention, rehabilitation or therapeutic purposes. Psychomotricity therapy is often used with children or adolescents suffering from osteosarcomas.

Design and characterization of a novel permanent magnet synchronous motor used in a growing prosthesis for young patients with bone cancer.

Approximately 50 child sarcomas are treated with limb salvage surgery each year in the United Kingdom. These children need an extendable implant that can be lengthened periodically to keep pace with the growth in the opposite limb. Surgically, invasive devices have been used for the past 30 years with intrinsic problems of infection and long-term recurrent trauma to the patient. To eliminate problems associated with the invasive device, a noninvasive extendable prosthesis was developed. The magnetically coupled drive technology used for this prosthesis was a synchronous motor with a gear-driven telescoping shaft. In this design the motor configuration was in two parts: a rotating magnet (rotor) that fitted inside the prosthesis where space was limited and the stator, which was an external device used to extend the prosthesis remotely as the patient grew. This compact external drive produced a focused magnetic flux that required no cooling and operated on a single-phase power supply. The extending mechanism in the implant was able to overcome up to 1300 N force, which is the tension force exerted by the soft tissues during the lengthening procedure. The device has been successfully implanted in 50 patients.

Rehabilitation for limb salvage patients: kinesiological parameters and psychological assessment.

Osteosarcoma is the most frequently occurring primary malignant tumor of bone, especially in adolescence. Treatment involves either limb salvage surgery or amputation with neoadjuvant chemotherapy. This review article discusses the current treatment modalities for osteosarcoma and also compares the gait patterns and psychosocial profiles of patients treated with either limb salvage surgery or amputation for osteosarcoma. Contemporary orthopedic literature on therapeutic options for osteosarcoma patients is reviewed. Background information on the basic principles of kinesiology, with emphasis on studies of gait pattern differences among patients treated with limb salvage versus amputation, is presented. Finally, several studies of the psychologic profiles of patients after these two procedures for osteosarcoma are reviewed. Trends in contemporary orthopedic literature suggest that functional outcomes, in terms of kinesiologic parameters, are comparable for patients treated with either limb salvage or amputation. Both sets of patients reported quality-of-life problems, including difficulty retaining health insurance and finding appropriate employment, social isolation, and poor self-esteem. The management of patients with osteosarcoma includes not only an individualized surgical plan for each patient but also includes awareness of the patients' psychologic and social needs after surgery.

[Patient medical rehabilitation following osteoplastic operations using hydroxylapatite-based porous ceramic]. / Meditsinskaia reabilitatsiia bol'nykh posle kostnoplasticheskikh operatsii s ispol'zovaniem poristoi keramiki na osnove gidroksilapatita.

At the URIOP Department of Tumours of the Locomotor System, osseous plastic operations were performed with making use of hydroxilapatite-base porous ceramics in 60 patients with benign tumours of bone and tumour-like lesions of bone. Apart from surgery the patients underwent a complex of rehabilitative measures, such as remedial gymnastics, massage, designed to restore locomotor functions of the extremity. Time periods of medical rehabilitation of patients were found to have gotten reduced by 1 to 2 months on the average providing the multimodality treatments with remedial gymnastics and massage were administered.