{"entity":{"id":"rejuv-recon-limb","kind":"technology","name":"Limb salvage, amputation, and the rehabilitation that follows either","aka":[],"tldr":"Saving a limb with a metal endoprosthesis gives better walking efficiency and better return to normal living than an above-knee amputation, and studies that asked patients about overall quality of life found the two closer than expected. On the Toronto Extremity Salvage Score, lower limb amputees scored 72.2 against 85.5 after extended resection.","summary":"The corpus holds `limb-salvage-surgery` as the record of the operation. This record is about what either path leaves a person able to do.\n\nFunction. A Dutch cross-sectional survivorship study of 97 people treated for locally advanced extremity soft tissue sarcoma two to ten years after diagnosis compared isolated limb perfusion with resection, extended resection, primary amputation and secondary amputation after perfusion. On the Toronto Extremity Salvage Score for the lower limb, the amputation groups scored 72.2 and 50.9 against 84.5 and 85.5 for the limb-sparing groups (p below 0.001); for the upper limb, 68.9 and 71.6 against 93.3 and 91.1 (p equals 0.007). Physical functioning on the standard cancer quality of life questionnaire was 62.7 and 65.7 for the amputation groups against 78.0 and 82.7 (p equals 0.001), and role functioning differed too. Cancer worry, anxiety and depression did not differ between any of the groups.\n\nEnergy cost. A smaller comparison of 20 patients treated around the knee measured the Physiological Cost Index, which is the heart rate cost of walking a given distance, and the Reintegration to Normal Living Index. Limb salvage was better on both. The same study found that the Toronto score and the general health questionnaire were similar between the groups, and concluded that limb salvage \"offers better gait efficiency and return to normal living compared with above-knee amputation, but does not improve the patient's perception of quality of life\". Two of those three findings are routinely quoted and the third rarely is.\n\nPooled evidence. A 2023 meta-analysis of five studies and 245 patients with lower extremity tumours found the standardised mean differences all slightly favoured limb salvage without reaching significance: 0.72 for physical function and 0.04 for mental health. With 245 patients across five heterogeneous studies this is a demonstration that the question has not been answered at scale rather than evidence of equivalence.\n\nWhen salvage fails. Limb salvage is not a single event; endoprostheses loosen, wear and become infected, and some patients come to amputation years later. An interview study of people who had a secondary amputation after primary limb salvage found that amputation was experienced as an improvement after a long period of poor function, and that the participants wanted the option discussed earlier. That is a qualitative finding in a small sample, and it is the one most likely to be missing from a consultation.\n\nRehabilitation after amputation. Prosthetic rehabilitation after cancer amputation differs from the commoner vascular and traumatic cases in three ways that are worth stating: the patient is often having chemotherapy at the same time, which affects wound healing, weight and energy; many are children or young adults who will grow and will need successive sockets; and the stump may have been irradiated. Rehabilitation is socket fitting, gait retraining, strength work for the remaining limb and trunk, and management of phantom limb pain. The randomised evidence for any specific prosthetic rehabilitation protocol in cancer amputees is essentially absent, and the practice is extrapolated from the general amputee literature.\n\nWhat comes back, and when: walking comes back in both groups, over months, and the difference is in how efficient and how unthinking it is. Running, kneeling and heavy lifting usually do not come back after a knee endoprosthesis, and the implant has a finite life that will need revising.","status":"standard-of-care","asOf":"2026-10-02","wikipedia":"https://en.wikipedia.org/wiki/Limb-sparing_techniques","links":[{"label":"Health-related quality of life after isolated limb perfusion compared to extended resection or amputation for locally advanced extremity sarcoma (Eur J Surg Oncol 2022)","url":"https://doi.org/10.1016/j.ejso.2021.08.007"},{"label":"Does limb-salvage surgery offer patients better quality of life and functional capacity than amputation? (Clin Orthop Relat Res 2012)","url":"https://doi.org/10.1007/s11999-012-2271-1"},{"label":"Comparing quality of life in lower extremity tumor patients undergoing limb salvage surgery and amputation: a meta-analysis (Front Oncol 2023)","url":"https://doi.org/10.3389/fonc.2023.1201202"},{"label":"Secondary amputation: a qualitative study of quality of life after primary limb salvage surgery (J Rehabil Med 2025)","url":"https://doi.org/10.2340/jrm.v57.34888"}],"tags":["rejuvenation","survivorship","rehabilitation","evidence:moderate"],"related":[],"cancers":["sarcoma","osteosarcoma","ewing-sarcoma"],"sections":["rejuvenation","surgery"],"technologies":["limb-salvage-surgery","isolated-limb-perfusion","rejuv-rehab-assistive-devices","rejuv-rehab-cancer-rehabilitation","rejuv-rehab-scar-contracture","exercise-prescription-after-cancer"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["limb-salvage-term","quality-of-life"],"trials":[],"people":[],"bottlenecks":["b-survivorship","b-toxicity-qol"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"A limb's job is to bear load and to move a joint through a range. An endoprosthesis restores both mechanically but has no muscle attachment of its own and no biological repair, so it fails by loosening, wear and infection. A prosthetic limb restores load bearing through a socket on soft tissue, which is why socket fit, skin tolerance and the energy cost of walking dominate the outcome.","strengths":["Better walking efficiency and reintegration than above-knee amputation","Task-specific function scores consistently favour limb salvage","Anxiety, depression and cancer worry do not differ between the paths"],"limitations":["Overall self-rated quality of life differs much less than function does","The pooled evidence rests on 245 patients across five heterogeneous studies","No randomised evidence for any prosthetic rehabilitation protocol specific to cancer amputees"]},"route":"/technologies/rejuv-recon-limb/","neighbours":{"cancer":[{"id":"ewing-sarcoma","kind":"cancer","name":"Ewing sarcoma","route":"/cancers/ewing-sarcoma/"},{"id":"osteosarcoma","kind":"cancer","name":"Osteosarcoma","route":"/cancers/osteosarcoma/"},{"id":"sarcoma","kind":"cancer","name":"Sarcomas (soft tissue, bone, GIST)","route":"/cancers/sarcoma/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"technology":[{"id":"rejuv-rehab-cancer-rehabilitation","kind":"technology","name":"Cancer rehabilitation: the discipline that puts function back","route":"/technologies/rejuv-rehab-cancer-rehabilitation/"},{"id":"isolated-limb-perfusion","kind":"technology","name":"Isolated limb perfusion and infusion","route":"/technologies/isolated-limb-perfusion/"},{"id":"limb-salvage-surgery","kind":"technology","name":"Limb-salvage surgery and endoprosthetic reconstruction","route":"/technologies/limb-salvage-surgery/"},{"id":"rejuv-rehab-scar-contracture","kind":"technology","name":"Scars, stiffness and contracture: shoulders, necks and jaws","route":"/technologies/rejuv-rehab-scar-contracture/"},{"id":"rejuv-rehab-assistive-devices","kind":"technology","name":"The devices that do the restoring, and who pays for them","route":"/technologies/rejuv-rehab-assistive-devices/"},{"id":"exercise-prescription-after-cancer","kind":"technology","name":"The exercise prescription after cancer: the dose the guidelines state","route":"/technologies/exercise-prescription-after-cancer/"}],"term":[{"id":"limb-salvage-term","kind":"term","name":"Limb-salvage surgery","route":"/terms/limb-salvage-term/"},{"id":"quality-of-life","kind":"term","name":"Quality of life","route":"/terms/quality-of-life/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}]}}