Why Rotationplasty? A Qualitative Study of Decision-Making by Families of Patients With Primary Bone Sarcoma.

Rotationplasty is an established technique that is indicated as part of the surgical reconstruction for certain patients with primary bone tumors around the knee who undergo tumor resection. There is considerable variation in the application of rotationplasty by surgeons as well as acceptance of the procedure by patients who may be candidates for this procedure. We qualitatively studied the decision-making process of families of patients who had undergone rotationplasty by interviewing 4 patients and their families using semi-structured interviews. Thematic analysis identified the following themes that were important in the decision-making process: (1) the desire for good information sources, (2) finding value in meeting with other patients who had been faced with a similar decision, (3) prioritizing function over cosmesis, (4) a desire to limit the need for revision surgeries, and (5) accepting that a return to normalcy is not an option with a surgery. Physicians and patients faced with a similar decision can benefit from a better understanding of the process, and by the normalization of anxieties and concerns that they may experience.

Functional outcomes and gait analysis of patients after periacetabular sarcoma resection with and without ischiofemoral arthrodesis.

BACKGROUND: Treatment of periacetabular sarcomas remains a difficult challenge. Many reconstruction options are fraught with high complication and failure rates. Little is known about patients' functional outcomes, and there have been no studies that examine how these reconstructions affect patients' gait parameters. The purpose of this study is to evaluate gait parameters and functional outcome in patients whom have undergone periacetabular resections with either an ischiofemoral pseudoarthrodesis or soft tissue reconstruction only. METHODS: Ten patients with sarcoma of the periacetabular region were identified from our database. Functional outcome was assessed using the Musculoskeletal Tumor Society Scores (MSTS) and Toronto extremity salvage score (TESS) scoring systems. Gait analysis was performed on all subjects. RESULTS: Patients in both surgical groups had average functional scores. All patients were ambulatory. Cadence and velocity in the surgical group were significantly slower than the control group, however, the remainder of the gait parameters examined were similar to controls. CONCLUSION: Patients who underwent minimal reconstruction following periacetabular resections demonstrated average functional scores, comparable to those undergoing more extensive reconstructions. With the exception of speed, gait parameters were not significantly different than controls. Complication rates were low. Pseudoarthrodesis or even no bone reconstruction following periacetabular resection is reasonable and functional options for many of these patients.

Deficit in human muscle strength with cast immobilization: contribution of inorganic phosphate.

Metabolic factors have been proposed to explain strength deficits observed in skeletal muscle with immobilization that are not completely accounted for by changes in muscle cross-sectional area (CSA) and neural adaptations. The aim of this study was to quantify changes in the resting inorganic phosphate (Pi) concentration from the medial gastrocnemius muscle during immobilization, reloading and rehabilitation. Additionally, we assessed the contributions of CSA, muscle activation and Pi concentration to plantar flexor torque during rehabilitation following immobilization. Eight persons with a surgically stabilized ankle fracture participated. Subjects were immobilized for 6-8 weeks and subsequently participated in 10 weeks of rehabilitation. Localized (31)P-Magnetic resonance spectroscopy, magnetic resonance imaging, isometric torque and activation testing were performed on the immobilized and uninvolved limbs. At 6 weeks of immobilization, significant differences were noted between the immobilized and uninvolved limbs for the Pi concentration and the Pi/PCr ratio (P < 0.05). From 6 weeks of immobilization to 3-5 days of reloading, the increase in Pi concentration (15%, P = 0.26) and Pi/PCr (20%, P = 0.29) was not significant. During rehabilitation, the relative contributions of CSA, muscle activation and Pi concentration to plantarflexor torque were 32, 44 and 40%, respectively. Together, CSA, muscle activation and Pi concentration accounted for 76% of the variance in torque (P < 0.01). In summary, our findings suggest that immobilization, independent of reloading, leads to a significant increase in the resting Pi concentration of human skeletal muscle. Additionally, alterations in resting Pi concentration may contribute to strength deficits with immobilization not accounted for by changes in muscle CSA or neural adaptations.