Gait outcomes following proximal tibial tumor resection and endoprosthetic reconstruction

Abstract

Background: Despite the proximal tibia being a common site of primary malignant bone tumors, there is limited information about gait function following proximal tibial tumor resection and endoprosthetic reconstruction (PTR).

Research question: What is the impact of PTR on gait and quality of life?

Methods: This was a cross-sectional study of patients ≥18 years old who were ≥2 years post-PTR compared to a control group of similar age and sex distribution. Eighteen participants (9 PTR, 9 Control) were recruited. Gait spatial-temporal data, joint kinematics and kinetics were collected at preferred and fast walking speeds. Community walking cadence, health-related quality of life (SF-36) and knee joint torque were assessed. Comparisons were performed using one-way ANOVAs with Bonferroni corrections for multiple comparisons. Nonparametric tests were used for data not normally distributed.

Results: Mean age was 31 years for each group (PTR range = 18-42 yrs, Control range = 18-44 yrs). Compared to both control and nonsurgical limbs, the surgical limb exhibited significantly decreased % single limb support time, reduced heel rise during terminal stance and an absence of normally occurring knee flexion angles, extensor moments and power generation during initial double limb support. Additionally, a reduced peak plantar flexor moment was found for the surgical as compared to the control limb. The number of gait abnormalities increased during fast walking. Significantly reduced surgical knee extensor torque on isokinetic testing and weakness of the knee and ankle on clinical examination support gait findings. During community walking, the number of low frequency strides was an average of 5.3 % greater for the PTR group (p < 0.05). Norm-based PTR group SF-36 component scores were within normal values (53.4 physical, 56.5 mental).

Significance: Gait abnormalities were consistent with ankle muscle resection and transposition and knee extensor mechanism disruption. Despite these deficits, walking speed and quality of life were relatively normal.

Keywords: Community walking; Gait; Limb salvage; Proximal tibia; Quality of life; Tumor.