Early ambulation during hospitalization after lower limb salvage surgery for bone and soft-tissue sarcomas: An observational retrospective study

Abstract

Introduction: Evidence on early functional recovery and inpatient physiotherapy after lower limb salvage surgery for bone sarcomas is limited

Objective: This study aims to describe early ambulation and explore potential prognostic factors.

Methods: A retrospective cohort study was conducted, including patients aged 12–70 years with bone and soft-tissue sarcoma who underwent lower limb resection and reconstruction between 2019 and 2023. The primary outcome was time to ambulation, and the secondary outcome was length of hospital stay.

Results: A total of 84 patients were included in this study. The median time to ambulation was 4 post-operative days (interquartile range [IQR], 4), and the median length of stay was 8 (IQR, 4). In multivariable Cox regression, earlier ambulation was associated with tumor location in the diaphysis/other sites (hazard ratio [HR] = 4.39, p =0.002), older age (HR = 1.02 per year, p =0.006), and higher physiotherapy intensity when initiated on post-operative day 1 (HR = 1.74, p =0.001). Bone graft/other procedures were associated with a lower hazard of ambulation compared with prosthetic reconstruction (HR 0.46, p =0.037). Each additional day of ambulation was associated with a 12% lower hazard of discharge (HR = 0.88, p =0.009).

Conclusion: Early mobilization and intensive physiotherapy appear to facilitate functional recovery following lower limb salvage surgery for bone and soft-tissue sarcomas. These findings emphasize the value of structured, staff-led rehabilitation programs that actively encourage and guide recovery, highlighting the role of clinical staff in optimizing post-operative outcomes and may improve patients’ independence.

Keywords

Bone sarcoma / Physiotherapy / Early ambulation / Lower limb salvage surgery / Risk factors / Length of stay

Acknowledgements

We would like to thank the entire oncology physiotherapy team, the nursing staff, and the patients of the orthopedic oncology surgery unit of IRCCS Istituto Ortopedico Rizzoli for their valuable advice and assistance.

Funding

This research was funded by the Ministry of Health, through the 5 million 2021 contribution (income year 2020) to the Rizzoli Orthopaedic Institute (grant no. 5M-2021-23683816).

Conflict of interest

The authors declare they have no competing interests.

Author contributions

Conceptualization: Mattia Morri, Marco Cotti

Formal analysis:Mattia Morri, Riccardo Ruisi

Investigation: Marco Cotti, Riccardo Ruisi

Methodology: Mattia Morri, Pietro Cimatti, Davide Maria Donati

Writing–original draft: Mattia Morri

Writing–review & editing: Pietro Cimatti, Marco Cotti, Davide Maria Donati

Ethics approval and consent to participate

The study was approved by the Ethics Committee of the Vast Area of Central Emilia with protocol no. 111/2024/Oss/IOR_EM1.

Consent for publication

Informed consent was waived by the Ethics Committee. Consent for publication was not obtained, and no identifiable information was collected or reported.

Availability of data

The data are available from the corresponding author on reasonable request.

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