Innovative Limb Salvage: Complex Orthopedic Reconstruction and Rehabilitation Following Chondroblastic Osteosarcoma of the Left Femur

Case Diagnosis: 27-year-old male underwent total femur, knee and hip replacement for treatment of chondroblastic osteosarcoma of the left femur.

Case Description or Program Description: After initial chemotherapy, the patient underwent a series of complex orthopedic procedures for tumor resection and limb reconstruction. This included radical resection of the entire left femur, followed by hip reconstruction with hemiarthroplasty and total knee arthroplasty. Given the extent of tissue involvement, additional interventions were performed, including quadricepsplasty, sciatic nerve neuroplasty, and muscle flap grafting using the gluteus medius, minimus, maximus, and vastus lateralis. Additionally, hip capsule repair and adjacent tissue rearrangement ensured functional recovery and limb stability.

Setting: Acute inpatient rehabilitation

Assessment/Results: Upon admission, the patient required maximum assistance for all ADLS, transfers, and ambulation. Starting rehabilitation four days post-surgery, the patient made remarkable progress. Within ten days, he achieved full independence in all ADLs, including dressing, grooming, transfers, ambulation, and self-care, discharged home with outpatient therapies.

Discussion (relevance): This case highlights the complexity of limb salvage following osteosarcoma resection. Key surgical interventions played vital roles in preserving function. Neuroplasty preserved sciatic nerve function, critical for lower extremity mobility. Quadricepsplasty restored knee extension, enabling weight-bearing and ambulation. Muscle flap grafting provided hip stability, aiding tissue healing and mobility. Together with early rehabilitation interventions, the patient achieved rapid recovery and full independence in ADLs and mobility. Compared to more conventional procedures like amputation, limb salvage allowed for excellent functional outcomes with a short stay in acute rehabilitation.

Conclusions: This case underscores the importance of early intensive rehabilitation following limb salvage procedures. Early mobilization and rehabilitation can significantly optimize functional recovery, shorten hospital stays, and reduce rehabilitation time for complex oncologic reconstructions. In cancer rehabilitation, early intervention is crucial as patients may require adjunctive chemotherapy or radiation after discharge. The integration of surgical precision and early rehabilitation enhances short-term recovery and long-term quality of life.