Comparative Study of Functional Outcomes in Limb Salvage versus Amputation in Osteosarcoma Patients.

Rahul  Anshuman; Saurabh  Kumar; Surya  Prakash

doi:10.51168/sjhrafrica.v7i2.2739

Authors

Rahul Anshuman Associate Professor, Department of Orthopaedics, Netaji Subhas Medical College, Patna, Bihar, India
Saurabh Kumar Associate Professor, Department of Orthopaedics, NSMCH, Jamshedpur, Jharkhand, India
Surya Prakash Assistant professor, Department of Orthopaedics, Shivam Ashoka Medical College & Hospital, Belchhi, Harnaut, Patna, Bihar, India;

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2739

Keywords:

Limb salvage, osteosarcoma patients, amputation, mobility, Functional outcome, Musculoskeletal Tumor Society score

Abstract

Background:

Osteosarcoma is the most common primary malignant bone tumor among adolescents and young adults. Advances in chemotherapy and reconstructive techniques have increased the use of limb salvage surgery as an alternative to amputation. However, comparative data regarding functional outcomes in resource-limited settings remain limited.

Aim:

To compare the functional outcomes of limb salvage surgery and amputation in osteosarcoma patients attending a tertiary care hospital.

Methods:

This retrospective observational study was conducted over two years at a tertiary care hospital and included 35 histopathologically confirmed osteosarcoma patients who underwent either limb salvage surgery or amputation. Demographic details, treatment modality, postoperative complications, mobility, and functional outcomes were collected from hospital records. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system. Statistical analysis was performed using Student's t-test and Chi-square test.

Results:

The mean age of participants was 18.4 years, with males constituting 62.9% (n=22) of the study population. Limb salvage surgery was performed in 22 (62.9%) patients, while 13 (37.1%) underwent amputation. The mean MSTS score was significantly higher in the limb salvage group compared with the amputation group (25.6 vs. 18.2; p=0.01). Patients undergoing limb salvage demonstrated better mobility and overall satisfaction. Postoperative complications included infection (17.1%), phantom limb pain (14.3%), local recurrence (11.4%), and implant failure (8.6%).

Conclusion:

Limb salvage surgery provides superior functional outcomes and improved quality of life compared with amputation despite a higher risk of postoperative complications.

Recommendation:

Limb salvage surgery should be considered whenever oncologically feasible, while ensuring careful patient selection, multidisciplinary care, and long-term follow-up.

References

Xu M, Tu J, Huang Y, Wang B, Zhao Z, Lin T. Comparison of oncological and functional outcomes in Lower-limb osteosarcoma pediatric patients : a large single-center retrospective cohort study. Int J Surg. 2024;(March):4208-20. https://doi.org/10.1097/JS9.0000000000001340

Rudyan J, Ige W, Astawa P. Comparison of Outcome Between Neoadjuvant Chemotherapy with Limb Salvage Surgery and Amputation with Chemotherapy in Osteosarcoma Patients : A Systematic Review. 2026;20(1):78-83. https://doi.org/10.5704/MOJ.2603.009

Saev S, Richardson CJ, Klueh ME, Tiesenga F. Long-Term Psychosocial and Functional Outcomes of Limb Salvage Surgery Versus Amputation : A Review Article. 2022;13(5):1-4. https://doi.org/10.19080/OAJS.2022.13.555871

Savio SD, Deslivia MF, Astawa P, Wiratnaya IGE. The Outcome Comparison of Limb Salvage Surgery versus Amputation for High ‑ Grade Osteosarcoma : A Systematic Review and Meta ‑ Analysis of the Last 7 ‑ Year Studies. 2020;67-73. https://doi.org/10.4103/jotr.jotr_52_19

Ullah F, Altaf W, Khan D, Khan NA, Akbar S, Muhammad Z. Comparative Outcomes of Limb Salvage Surgery Versus Amputation in Osteosarcoma : A Five-Year Follow-Up Study From a Tertiary Care Center. 2025;17(10). https://doi.org/10.7759/cureus.94881

Zhu Y, Wu X, Zhang W, Zhang H. Limb-salvage surgery versus extremity amputation for early-stage bone cancer in the extremities: a population-based study. Front Surg [Internet]. 2023;10(May):1-11. https://doi.org/10.3389/fsurg.2023.1147372

Manandhar S, Li J, Zhang Y, Lu X, Zhang Y, Liu Y. A Comparative Study on the Clinical and Functional Outcome of Limb Salvage Surgery and Amputation in Tibial Osteosarcoma. NORTH Am Acad Res J. 2021;4(3):179-91.

Li X, Zhang Y, Wan S, Li H, Li D, Xia J. A comparative study between limb-salvage and amputation for treating osteosarcoma. J Bone Oncol. 2016;5:15-21. https://doi.org/10.1016/j.jbo.2016.01.001

Kaneuchi Y, Yoshida S, Fujiwara T, Evans S. Limb salvage surgery has a higher complication rate than amputation but is still beneficial for patients younger than 10 years old with osteosarcoma of an extremity. J Pediatr Surg [Internet]. 2022;57(11):702-9. https://doi.org/10.1016/j.jpedsurg.2022.04.001

Evans DR, Lazarides AL, Visgauss JD, Somarelli JA, Iii DGB, Brigman BE, et al. Limb salvage versus amputation in patients with osteosarcoma of the extremities : an update in the modern era using the National Cancer Database. BMC Cancer. 2020;20(995):1-11. https://doi.org/10.1186/s12885-020-07502-z https://doi.org/10.21203/rs.3.rs-18262/v1