Physical therapy following hip and knee tumoral prosthesis and total femur replacement revision surgery for bone sarcoma, a case report
Journal of Clinical Physiotherapy Research,
Vol. 10 No. 1 (2025),
15 November 2025
,
Page 1-7
https://doi.org/10.22037/jcpr.v10i1.50788
Abstract
Introduction: Background and Purpose: Bone sarcomas are rare malignant bone tumors, and large lesions often necessitate complex Limb-Salvage Surgery (LSS), such as Total Femur Replacement (TFR). While LSS is the standard of care, there is a paucity of detailed, evidence-based rehabilitation protocols, especially for patients undergoing extensive, multi-joint reconstructions. This case report aims to document the effect of a structured, early post-operative physical rehabilitation program in a patient who underwent TFR for extensive femoral sarcoma. Case presentation: A 54-year-old male with recurrent osteosarcoma and multiple prior surgeries underwent a revision Total Hip and Knee Replacement with TFR. Six weeks post-surgery, the initial assessment revealed severe pain (visual analog scale: 6), major limitations in Range of Motion (ROM) (e.g., knee flexion 30∘), and severe muscle weakness (manual muscle testing (MMT: 1 in most muscles). Outcomes: The patient underwent a 20-session structured rehabilitation program focusing on pain management (High-Frequency TENS), early ROM recovery (Continuous Passive Motion (CPM)), and progressive strengthening. After 20 sessions, the patient achieved a significant pain reduction to VAS: 2 and significant ROM recovery, including 90∘ of knee and hip flexion. Functional progress was seen as the patient moved from a partial weight-bearing walker to walking with a single cane. The primary residual challenge was severe knee extensor (quadriceps) weakness (MMT: 2), causing the knee to "give way". Conclusion: This case demonstrates that a structured and progressive early rehabilitation protocol is highly effective in achieving rapid pain control and significant recovery of joint range of motion following complex TFR. The persistence of severe quadriceps weakness is a known challenge that requires targeted intervention.
- Rehabilitation, Physical therapy, Bone tumor, Prosthesis, Total femur replacement, Hip arthroplasty, Knee arthroplasty
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References
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