STANDARDISING FUNCTIONAL ASSESSMENT AFTER LIMB SPARING SURGERY IN EXTREMITY SARCOMA - OBJECTIVE VS SUBJECTIVE SCORING SYSTEM

Dr. Gurumoorthy Narayanasamy; Dr. Subbiah Shanmugam; Dr. Gopu Govindasamy; Dr. Syed Afroze Hussain

Volume : VII, Issue : VII, July - 2018

STANDARDISING FUNCTIONAL ASSESSMENT AFTER LIMB SPARING SURGERY IN EXTREMITY SARCOMA - OBJECTIVE VS SUBJECTIVE SCORING SYSTEM

Dr. Gurumoorthy Narayanasamy, Dr. Subbiah Shanmugam, Dr. Gopu Govindasamy, Dr. Syed Afroze Hussain

Abstract :

Introduction: While advances in reconstructive surgery and effective chemotherapy regimens for bone sarcomas, have facilitated limb preservation in extremity sarcomas, limited information exists regarding their functional outcome, most such data being from subjective analytical methods. Drawbacks of subjective scoring systems are difficulty in interpretation by patients and problem of undefined intermediate scores between defined variables. We have formulated an easy to apply, objective scoring system which will not be confounded by patient�s age and differences in inter individual interpretation. Objective: The primary objective of this study is to assess the functional outcome after limb salvage surgery in patients with extremity sarcomas using both subjective and objective methods of analysis. Correlation of objective with subjective score, influence of age, gender, pathology, radiotherapy, extent of soft tissue resection, bone resection, recurrent disease and rehabilitation on the scores & outcome were also assessed Materials And Methods: The functional outcome of 54 patients with extremity sarcomas, both soft tissue and bone tumors , who underwent limb sp� surgery at our department between 2014–2016 were analysed using MSTS subjective scoring system and by an institution designed objective scoring system. Patients were assessed post operatively at 4th, 5th and 6th month. The mean scores were analysed for overall outcome and for different subsets. Results: We observed a significant difference in outcome with adequate postoperative rehabilitation. There was no influence on outcomes due to gender, radiotherapy, pathology or recurrent status. Though there was no significant difference in outcome among various subsites of lower limb or among different compartments of thigh, resection of quadriceps and tibial resection resulted in inferior function. Conclusion: This study revealed that objective scoring is feasible, providing a reproducible method to assess functional outcome with a strong positive correlation with subjective score. Together they complement each other for better assessment of functional status. Newer systems with combination of objective and subjective factors may be better for comprehensive analysis in the future.