Preoperative and early postoperative rehabilitation of children and adolescents with bone tumors at different stages lower of limb joint replacement

Abstract

Endoprosthetic replacement is a surgical part of treatment for bone tumors in pediatric patients. Due to the large extent of such surgery, patients require not only postoperative rehabilitation of motor deficits but also preoperative rehabilitation. Objective: to undertake a comparative analysis of the effectiveness of preoperative rehabilitation before lower limb joint replacement and early postoperative rehabilitation (e.g. supine-to-stand transfer). We conducted a retrospective non-randomized study which included patients (n = 81) with malignant bone tumors of the lower limb (osteosarcoma and Ewing sarcoma). The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation. Patients allocated to the group of interest (n = 46) received preoperative rehabilitation therapy which started two weeks before surgery; patients in the control group (n = 35) started their rehabilitation on the first postoperative day. In both groups, we assessed muscle strength, autonomic nervous system function and the recovery of range of motion in the reconstructed joint on the first postoperative day and before discharge from the hospital. Patients from the group of interest showed normal autonomic responses more frequently; they demonstrated better restoration of autonomic nervous system function and recovery of range of motion and higher average muscle strength score. The study showed that preoperative rehabilitation has a positive effect on the recovery of motor function post surgery in patients treated with lower limb joint replacement.