Toronto extremity salvage score-patient reported outcome measures in upper extremity bone tumors treated with limb salvage surgery

Abstract

Bone and soft tissue tumors of upper extremity are relatively uncommon than those of lower limb. Treating these patients while retaining a functional limb is quite a challenge. Along with musculoskeletal tumor society score, Toronto extremity salvage score (TESS) is most widely used patient-reported outcome measure for sarcomas of upper extremity. Retrospective analysis of patients with upper extremity bone tumors (24) treated with limb salvage surgery (20) from 2014 to 2022 was undertaken.  Mean follow-up period was 26 months and mean age was 30.2 years. Out of 20, 11 humerus cases were of tumors arising from humerus, 5 in radius and 3 in ulna. 9 patients were treated with custom mega prosthesis reconstruction, 6 with fibular free flap, 6 radius underwent simple resection and 1 curettage. Majority of the cases were giant cell tumors (8) followed by osteosarcoma (3), fibromatosis (3), aneurysmal bone cyst (2), simple bone cyst (2), 1 Ewing sarcoma and 1 metastatic bone disease. The mean TESS score of the sample population was 69.7 Most of the patients (11) rated their disability to be of moderate degree and considered themselves to be moderately disabled. The mean TESS score for CMP group was 71.1, while that of autograft reconstruction was 68.3. Despite only half the population having received CMP as a reconstructive option, nearly 40% patients with disease of forearm where the results are not so great, our study population reported a reasonably good patient reported outcome score. A dedicated physiotherapy team with tailor made exercise protocol for each patient depending on their needs can help in improving the quality of life.