Authors (including presenting author) :
Lam YHR1; Tsoi CWL 2; Lam P1; Wong CKC2;Kwong WCT3, Yau CHR4; Fang C5;Lam YL4
Affiliation :
1 Physiotherapy Department, QMH
2 Physiotherapy Department, MMRC
3. Prosthetic & Orthotic Department, MMRC
4 Division of General and Oncology, Department of O&T, QMH
5 Division of Trauma, Department of O&T, QMH
Introduction :
Myxofibrosarcoma is an uncommon soft tissue tumour in the elderly with high local recurrence rate’ Limb salvage surgery is desirable but not always feasible. Rotationplasty is an alternative to amputation that preserves better limb function and mobility by reusing a 180 degree rotated distal limb. However the rehabilitation of the patient is not a simple process and a multidisciplinary team (MDT) of orthopaedics surgeons, physiotherapists and prosthetists is vital for the patient to achieve maximal functional outcome.
We report a local experience with team approach rehabilitation that was successful in facilitating a quick return of function in a patient suffering from myxofibrosarcoma over the proximal thigh.
Objectives :
This paper aims at introducing the team approach on holistic rehabilitation on Van Nes Rotationplasty, a special operation in tumour surgery with which the distal limb is rotated 180 degree to resemble a new "knee joint" after resecting the tumour bone.
Methodology :
A 64 year-old patient was diagnosed with left thigh high grade myxofibrosarcoma and excision was done in 2012. He had recurrence and Van Nes Rotationplasty was performed by Orthopaedics surgeons in 2017.
The rehabilitation of the patient was divided into early phase, intermediate & prosthetic fitting phase, and late rehabilitation phase.
Early rehabilitation: Immediate ankle pumping exercise to facilitate movement of the new ‘knee joint’, neuromuscular retraining for elimination of visual confusion, early ambulation.
Intermediate & prosthetic fitting phase: Liaison between physiotherapists and prosthetists on preparation of muscle strength for prosthesis fitting. Practise of donning and doffing of prosthesis by prosthetist.
Final rehabilitation: Integration of functional training in daily activities with prosthesis.
Result & Outcome :
The pre-operation Modified Functional Ambulatory Category (MFAC)* was 4 (Assisted walker).
Post op new ‘knee’ range was 15-60 degree with a final range of 0-60 degree after course of rehabilitation.
Patient can don and doff the prosthesis without assistance upon completion of rehabilitation.
Walking exercise was started 4 weeks after surgery with assistance and achieved elbow crutches walking with prosthesis at final phase of rehabilitation, regaining a MFAC 7 of independency. Level ground, stairs and slope negotiated without problem.
MDT on rehabilitation could maximize the functional outcomes and facilitate faster effective recovery in patients with musculoskeletal tumour.
