Tumour & limb salvage: rehabilitation guide
Recovery after distal femoral replacement for bone tumour: early weight bearing, quadriceps programme, extension lag and honest goals.
What is inside
24 minutes to read. Reviews: Wound review at about 2 weeks. Clinical review with an X-ray at 6 to 8 weeks. Then reviews and surveillance imaging on a schedule the sarcoma team sets, which continues for years.
Harbour Orthopaedics & Sports Medicine
(02) 9052 1883 · drmatthewbroadhead.com.au
This is a general guide. Your operation record and the instructions you are given always take precedence over anything written here. Last reviewed 5 August 2026.
This guide covers recovery after a distal femoral replacement: a megaprosthesis that replaces the lower part of the thigh bone and the knee joint, using a rotating-hinge knee, after a bone or soft-tissue tumour is removed. It is written for patients of the RPA Bone & Soft Tissue Sarcoma Unit and for the physiotherapists, often on the Mid North Coast, a long way from Sydney, who will deliver most of the programme.
One rule sits above everything else in limb-salvage rehabilitation: the site of the reconstruction, not the diagnosis, determines the protocol. A distal femoral replacement and a proximal tibial replacement are both “knee megaprostheses”, yet they follow very different programmes. This one is comparatively liberal, the proximal tibial one is strictly immobilised, because different muscles and tendons are disturbed at each site. And within that, the operation record governs: what was removed, what was reattached and how the implant was fixed decide your restrictions, and Dr Broadhead’s operation note always overrides the general figures here.
A megaprosthesis replaces a segment of bone and the adjacent joint. The metal is fixed and stable straight away; what dictates your programme is which muscles had to be disturbed, here, chiefly the quadriceps, whose architecture and leverage are changed by the surgery. Recovery is measured in months, not weeks, and the functional ceiling is lower than after a standard knee replacement: most patients walk independently, with or without a stick, and return to daily activities, but not to running or impact sport. Early, staged, active rehabilitation is safe: reviews of limb-salvage rehabilitation show early active mobilisation does not increase dislocation or infection and is associated with better quality of life.
Three things are lifelong. Avoid impact loading, to limit wear. Expect that revision surgery is likely at some point over a lifetime. These implants are serviced, not set-and-forget. And keep lifelong vigilance for infection: deep infection is the most significant risk in this surgery, considerably more common than after standard joint replacement, and never a wait-and-see problem. Surveillance imaging of both the tumour site and the prosthesis continues for years.
The tumour was removed together with the segment of thigh bone (femur) it involved, including the knee end of the bone, with a margin of healthy tissue around it. The reconstruction is designed around what that removal required.
The missing bone and joint were replaced with a modular metal implant anchored in the remaining femur, connected to a component in the shin bone through a rotating-hinge knee. The hinge provides the stability that the resected ligaments can no longer supply, which is why there are no ligament-protection rules in this guide, and why the knee can be moved and loaded early.
The part that shapes your rehabilitation is the quadriceps: the muscle at the front of the thigh that straightens the knee. Removing the tumour changes the muscle’s architecture and its leverage over the new joint, even when the muscle itself is largely preserved. The central challenge of this entire programme is regaining active knee straightening: the knee will usually bend willingly enough, but making the quadriceps hold it straight under load is the work.
Limb-salvage programmes are built around what was removed and reattached, not around the name of the tumour. A distal femoral replacement rehabilitates very differently from a proximal tibial one, despite both being “knee” operations. Your operation record is the final word on your weight bearing, brace settings and pace, if anything here conflicts with your team’s instructions, your team is right.
Weight bearing is usually as tolerated early, and most patients are walking with full weight around the third post-operative week. A cemented implant is solid at once and progresses faster; an uncemented implant is protected while your bone grows into it, so its loading is advanced more slowly. Which you have is in the operation record: follow it.
An extension lag: a knee you can straighten with your hand but not hold straight with your muscle, is common after this operation, because the tumour surgery changes the quadriceps’ architecture and leverage. The programme attacks it relentlessly: quadriceps activation from day one, the straight leg raise as the key milestone, and graded loaded straightening work after that. A knee that straightens actively walks well; final bend usually ends up somewhat less than a native knee, and that trade is worth making.
Early bending is done as controlled movement in a hinged brace, with the permitted range set and advanced by your team. Flexion is advanced steadily and usually comes on well; the reason it is staged is to let the soft tissues heal in balance with the new mechanics, not because the hinge is fragile.
Most patients end up walking independently, with or without a stick, managing stairs and daily life. Running, jumping and impact sport are not part of the picture; final bend is usually somewhat less than a native knee. Knowing the ceiling from the start is how you recognise a good result when you reach it.
Your team may mention two scores. The MSTS score is the clinician’s rating of limb function from 0 to 100%. The TESS is your own rating of how difficult everyday tasks are. Good limb-salvage results typically land in the 70–85% range on these scales: good function, not normal function. A score in that range is a genuinely good outcome after this surgery.
Weight bearing
Usually as tolerated early, commonly reaching full weight bearing around the third post-operative week: faster with cemented fixation, protected longer with uncemented. The operation record governs.
The rotating-hinge implant is stable from the moment of surgery, so early standing and walking are safe and are part of the programme. Most patients progress to taking full weight around the third week after surgery.
The pace depends on how the implant was fixed. A cemented stem is at full strength immediately and progresses faster. An uncemented stem relies on your bone growing into its surface over the early weeks and is protected with partial weight bearing while that happens. Your team will tell you which you have and set your progression.
Weight bearing and walking aids are separate questions. You may be cleared for full weight long before you are ready to give up the crutches: the aids come off as your quadriceps control improves, not on a calendar date.
| Stage | Typical timing | Move on when |
|---|---|---|
| Wheeled frame or two crutches | From day 1, for the first weeks | Safe transfers; steady stepping in the brace |
| Two crutches, weight bearing progressing | Commonly full weight around week 3 (cemented); uncemented advanced on the team’s schedule | Comfort; wound settled; team confirmation for uncemented stems |
| One crutch or a stick (opposite hand) | Your team advances this as quadriceps control returns, typically well after the 6 to 8 week review | Straight leg raise achieved or nearly so; knee not giving way; gait controlled |
| Stick as needed | Over months: many keep a stick for distance | Confident, safe walking; active extension holding under load |
The hinge does not need ligament-style protection, but the soft tissues and the quadriceps mechanism do, and bone that has been operated on, and sometimes irradiated or exposed to chemotherapy, is more fragile than it looks. These rules protect the things that take months to heal.
| Rule | Why | How to manage |
|---|---|---|
| Wear the hinged brace as prescribed, at the settings prescribed | The brace lets the knee move through a controlled, team-set range while the soft tissues heal in balance with the new mechanics. | Only your team changes the dial settings, never adjust them yourself, and bring the brace to every review. |
| Respect your weight-bearing status if you have an uncemented stem | The implant’s long-term anchorage depends on bone growing into it undisturbed over the early weeks. | Use the aids exactly as prescribed until your team formally advances you, comfort is not the signal here. |
| No impact: no jogging, jumping, or twisting under load | Impact accelerates wear of the hinge and risks fracture through bone weakened by resection, radiotherapy and chemotherapy. | This one is permanent. Build exercise around walking, swimming and cycling instead. |
| Do not force the bend through sharp pain | Flexion is advanced steadily on the team’s schedule and usually comes on well; forcing it inflames the very tissues that allow it. | Work firmly into stretch within your permitted range; report a bend that is stuck rather than fighting it alone. |
| Period | Instruction |
|---|---|
| Early weeks | Worn for walking and, if your team directs, at rest and overnight: your team sets the exact schedule. |
| As quadriceps control returns | Your team weans the brace as your straight leg raise and gait control return, commonly over the first 6–12 weeks, but this is a decision made at review, not a date. |
| Period | Permitted range |
|---|---|
| From surgery | Set by your team at surgery: early controlled bending within a limited range, locked straighter for walking if directed |
| At each review | Advanced steadily by your team: flexion is opened up stage by stage as the soft tissues settle; do not adjust the dial yourself |
| Milestone | Earliest (weeks) | Typical | Latest |
|---|---|---|---|
| Standing and walking with frame or crutches, in the brace | 0 | 1 | 2 |
| Wound review | 2 | 2 | 3 |
| Full weight bearing (cemented; uncemented on the team’s schedule) | 2 | 3 | 8 |
| Clinical review with X-ray: brace and bend advanced | 6 | 7 | 8 |
| Straight leg raise without lag (the key milestone: individual) | 6 | 10 | 20 |
| Brace weaned (team decision) | 6 | 9 | 12 |
| One crutch or a stick | 8 | 12 | 20 |
| Desk work (individually confirmed) | 6 | 8 | 12 |
| Driving (criteria met, discussed with the team) | 8 | 12 | 20 |
| Three-month review | 12 | 13 | 14 |
| Surveillance imaging: schedule set by the sarcoma team, continuing for years | 12 | 13 | 52 |
You move to the next phase by meeting its exit criteria, not by the calendar. The week numbers are typical, nothing more.
Wake the quadriceps from day one, walk early in the brace, control swelling, and start controlled bending within the brace range.
Ready for the next phase when…
Progress towards full weight bearing, open the bend stage by stage, and make the straight leg raise the daily scoreboard.
Ready for the next phase when…
Graded, loaded straightening work, turning a quadriceps that can lift the leg into one that holds the knee straight under body weight.
Ready for the next phase when…
Endurance, strength and confidence for real life, honest expectations about the final bend, and the lifelong routine of surveillance.
Ready for the next phase when…
Little and often beats one heroic session. Each exercise lists what you should feel, sharp pain that lingers afterwards means ease off and, if it persists, call.
Keep blood moving in the calf: your main clot-prevention exercise.
10 firm pumps, every waking hour, for the first 2 weeks
Feel: You should feel the calf muscles working. Move through the full range each time.
The most important exercise in this guide: everything about your final walk depends on this muscle switching back on.
10 holds of 5 seconds, hourly while awake in the first weeks, then 3–4 times daily
Feel: You should feel and see the front of the thigh firm up. If the muscle will not fire, do not give up, put a hand on it, look at it, and keep asking; NMES can help if prescribed.
The key milestone of this whole programme: lifting the leg with the knee actively held straight, without a sag.
10 lifts, hold 3 seconds, 3 times daily: attempt from early on as your physiotherapist directs
Feel: A sag at the knee as you lift is the extension lag: expected at first after this surgery. Watching it shrink week by week is how you know the programme is working. Quality beats count: five honest lifts beat twenty with a sag you ignored.
Easier: If a full lift is not there yet, keep the leg on the bed and practise pressing the knee down and holding: the lag closes from the straight end first.
Help a reluctant quadriceps fire while its architecture and leverage recover.
Exactly as prescribed by your team, sessions are typically paired with your own active exercises
Feel: The stimulation should produce a strong, visible contraction that is uncomfortable but not painful. It supplements your own effort: the exercises still have to be done.
Safe, rhythmic early walking in the brace.
Short walks, several times a day, building distance gradually
Feel: Even step lengths. Let the brace do its job: walk within it, not against it.
Restore the bend safely, stage by stage, within the range your team has set on the dial.
10 slow bends to the permitted limit, 3–4 times daily
Feel: The dial setting is your team’s decision alone, never advance it yourself. Finish every session with the knee fully straight.
A smoother, more upright walk as weight bearing progresses.
Replace frame walks once your team progresses you; build distance week on week
Feel: Stand tall; look ahead, not at your feet. No back-knee thrust: if the knee is snapping back to feel stable, tell your physiotherapist.
Loaded straightening in the most useful movement you own: a core part of closing the extension lag.
2–3 sets of 8–10, once or twice daily
Feel: The slow lowering is where the quadriceps learns the most, do not flop.
Harder: Less arm assistance, then more of the load onto the operated leg: as your physiotherapist directs.
Calf strength for a normal push-off when walking.
2–3 sets of 10, once or twice daily
Feel: Even weight through both feet, or as your weight-bearing status allows.
Safe, repeatable stair climbing during the protected months.
Practise with your physiotherapist first, then as needed
Feel: “Good leg up first.” Slow and square beats quick and crooked.
The higher-risk direction: controlled descent protects the knee and your confidence.
Practise with your physiotherapist first, then as needed
Feel: “Operated leg and crutches down first.” If in doubt, go down sitting: dignity heals faster than a fall.
Soften and desensitise the scar once fully healed. A mobile scar also helps the bend.
2–3 minutes, twice daily, from about 3 weeks once healed and dry
Feel: Firm enough to blanch the skin slightly; it should not be painful. If you have had radiotherapy to the area, ask your team before starting.
Range, circulation and endurance with almost no joint load.
10–20 minutes, most days, once your permitted bend allows a full revolution
Feel: Mild stretch at the top of the pedal stroke is useful; lower the saddle gradually as the bend improves and your team permits.
Steadiness and confidence: protects you from trips and falls.
Build to 3 holds of 30 seconds each leg, daily, once your team clears single-leg loading
Feel: Quiet foot, tall posture. The knee wobbling forward is the quadriceps still learning: persist.
Sleep on your back or either side as comfort allows, with the brace on at night if your team has directed that.
Never rest a pillow under the knee itself. It teaches the knee to sit bent, which is exactly what the extension programme is fighting. If you want support, a pillow under the whole calf keeps the knee straight.
Disturbed sleep is common for some weeks and improves as swelling and pain settle. Ice before bed and timing pain relief for the night help.
Expect to need regular pain relief for the first few weeks, weaning gradually. Take medication ahead of exercise sessions rather than chasing pain afterwards, and wean the strongest medications first.
You will usually be on a blood thinner: take it exactly as directed.
If you are having chemotherapy, the rehabilitation and oncology timetables are coordinated by your team, energy levels, blood counts and treatment cycles all shape what each week looks like, and a slower fortnight during treatment is expected, not a setback.
Aching, warmth, tightness and tiredness after activity persist for months and are normal. Pain that is increasing week on week, or new pain at rest or at night, is not, call the rooms.
You may drive when all of the following are true:
What the research actually measures is braking reaction time on a simulator. Those studies show braking performance returns to its pre-operative level at about 2 weeks after a right hip replacement and about 4 weeks after a right knee replacement, with movement time back to normal by 6 weeks. After knee arthroscopy the simulator evidence is more conservative than common practice: in the one study that measured it directly, braking was still slower one week after surgery than before it, and had recovered by four weeks, and a 2021 review of eight studies put the average return at about six weeks. Most people having a simple arthroscopy are driving well before that, which is why the criteria above matter more than the date. But these are averages, in one study, about one in three right-hip patients still could not meet an emergency-stop benchmark at six weeks. Treat the timeframes in this guide as targets for discussion with us, not as permissions.
No published study has compared automatic and manual cars. The logical point is simply that a manual needs the left leg for the clutch, so left-sided surgery is the relevant caution in a manual. Advice about driving earlier with a left-leg operation in an automatic is clinical judgement, not trial evidence.
In Australia, your treating doctor’s advice governs: under the Austroads "Assessing Fitness to Drive" standards, temporary post-operative impairment is a matter of clinical judgement, and commercial drivers are held to a higher standard. Driving while impaired may invalidate your insurance, check your insurer’s position. Do not drive for at least 24 hours after any general anaesthetic or sedation.
| Activity | Typical | When it’s right | Notes |
|---|---|---|---|
| Walking for exercise | From the outset, with the prescribed aid and brace | Comfort and safety | The core of the programme: build distance gradually |
| Swimming and hydrotherapy | Once the wound is fully healed and your team agrees | Wound reviewed and closed; brace plan discussed for poolside | Excellent low-load exercise for both bend and strength |
| Stationary cycling | Once the permitted bend allows a revolution | Team-set range sufficient; saddle high | Progress time before resistance |
| Driving | Individually assessed | All the driving criteria below, discussed with the team, including being out of any brace that limits pedal movements | The active-straightening strength that makes an emergency stop safe is exactly what this programme rebuilds, do not shortcut it |
| Desk work | Commonly in the 6–12 week window. Your team will confirm | Comfortable sitting; transport sorted | Get up and move hourly; a footstool helps the knee rest straighter |
| Physical work | Individually assessed | Duties reviewed with the team | Heavy physical work is often not a realistic goal after distal femoral replacement, raise your actual duties early so modified duties or retraining can be planned honestly |
| Golf, bowls, doubles tennis and similar low-impact sport | Team-cleared, usually well after 3 months | Strength, balance and a trustworthy knee | Discuss the specific sport: rotation and uneven ground are the considerations |
| Running, jumping and impact or contact sport | Not part of life with a megaprosthesis | — | This is a permanent trade: impact accelerates wear of the hinge and risks fracture through bone weakened by resection, radiotherapy and chemotherapy |
| Air travel | Discuss with the team: see the travel notes in this guide | Clot prevention planned | Especially relevant for Mid North Coast patients travelling to Sydney for reviews. The same planning applies to long drives: break them up, move hourly |
You will often hear "no flying for six weeks" after joint replacement. Be aware that this is a convention, not a proven rule: a 2025 review found limited data and no demonstrated difference in clot risk between people who did and did not fly after hip or knee replacement: mostly within the first week.
The six-week convention reflects practical realities rather than trial evidence: managing airports and cramped seating, being past the highest-risk clot window while still on prevention, the higher baseline clot risk of long-haul flights over four hours, and individual airline and travel-insurance rules, check both, as some airlines impose their own restrictions.
If you need to travel long-haul in the first six weeks, talk to the rooms first so clot prevention, an aisle seat, stockings and on-board movement can be planned.
None of these should be watched overnight to see how they go. Early treatment of a problem is simple; late treatment is not.
EMERGENCY: 000Emergency department / call 000
GP TODAYSee your GP today
CALL THE ROOMSCall the rooms: same day
For joint replacement patients, a wound problem is never something to "wait and see". Early treatment of an infected joint replacement is vastly more successful than late treatment, call the rooms the same day.
You will usually stand and take your first steps with a frame within a day or two of surgery. The rotating-hinge implant is stable immediately. Most patients are taking full weight around the third week (sooner or later depending on how the implant was fixed), and the journey from crutches to a stick then plays out over months, not weeks, paced by how quickly your quadriceps control returns. Many people keep a stick for distance long term: a sensible adaptation, not a setback.
No, and it is better to hear that clearly at the start. Running, jumping and impact sport are not part of life with a megaprosthesis: impact accelerates wear of the hinge and risks fracture through bone weakened by the resection and by any radiotherapy or chemotherapy. The realistic and genuinely good outcome is independent walking, with or without a stick, a full daily life, and low-impact exercise such as walking, swimming and cycling.
An extension lag is a knee you can straighten with your hand but cannot yet hold straight with your muscle: the leg sags at the knee when you lift it. It is common after distal femoral replacement, because removing the tumour changes the quadriceps’ architecture and its leverage over the new joint, even when the muscle itself is preserved. It is also the central project of this programme: quadriceps activation from day one, the straight leg raise as the milestone, then graded loaded straightening work, sometimes with muscle stimulation or a supportive orthosis. Watching the lag shrink is how you know the programme is working.
Flexion is introduced early as controlled movement in the brace and advanced steadily by your team, and it usually comes on well. Honestly, though: final bend is usually somewhat less than a native knee. The programme deliberately prioritises active straightening over maximum bend, because a knee that straightens under load walks well and feels trustworthy. That is the trade that pays.
The hinged brace is worn from surgery through the early weeks, with the permitted bending range set and advanced by your team at each review, never adjust the dial yourself. It is weaned as your straight leg raise and gait control return, commonly over the first 6–12 weeks, but that is a decision made at review rather than a date on a calendar.
Because in limb-salvage rehabilitation the site of the reconstruction, not the diagnosis, determines the protocol. A distal femoral replacement and a proximal tibial replacement are both knee megaprostheses, yet one moves early and the other is immobilised for six weeks, different muscles and tendons are disturbed at each site. Within that, your own operation record governs: what was removed, what was reattached, and how the implant was fixed. If this guide and your team’s instructions differ, your team is right.
Two ways of measuring how the limb is doing. The MSTS score is the clinician’s rating of limb function on a 0–100% scale; the TESS is your own rating of how difficult everyday tasks are. Good limb-salvage results typically land in the 70–85% range. That means good function, not normal function, and a score in that range after a distal femoral replacement is a genuinely good outcome.
This is normal and it works well. Most of the hands-on rehabilitation happens locally, guided by the operation record and the protocol your Sydney team provides. Your physiotherapist is welcome: encouraged, to contact the rooms directly with questions, and the key decision points (advancing the brace range, weaning the brace, progressing weight bearing on an uncemented stem) are made at your reviews and communicated in writing. Bring this guide and your operation record to your first local appointment.
Deep infection is the most significant risk of this surgery: considerably more common than after standard joint replacement, partly because chemotherapy and radiotherapy affect healing and immunity. Watch for increasing pain, spreading redness, wound discharge, fever or feeling unwell, and call the rooms the same day, every time, for the rest of your life with the implant. Early treatment of an infected prosthesis is vastly more successful than late treatment. Also tell every future dentist and doctor you have a megaprosthesis before procedures.
The general convention after joint replacement is no long-haul flying for 6 weeks, though the evidence behind a fixed rule is limited, talk to the team before any early travel so clot prevention, seating and movement can be planned. The same logic applies to the long drive from the Mid North Coast: break the trip, get out and move every hour, do your ankle pumps, and travel as a passenger with room for the braced leg until you are cleared to drive.
Plan on it, calmly: over a lifetime, revision surgery of some kind is likely, bearings and hinge components wear, and the implant is serviced rather than permanent. This is one reason for the permanent no-impact rule and for the surveillance imaging of both the tumour site and the prosthesis, which continues for years: problems found early are far easier to fix.
| Claim | Source |
|---|---|
| The site of reconstruction, not the diagnosis, determines the rehabilitation protocol in lower-limb endoprosthetic surgery | Standardisation of rehabilitation after limb salvage surgery for sarcomas, Hematol Oncol Stem Cell Ther 2013 (PMID 24161605); functional outcomes of endoprosthetic reconstruction by site, Clin Orthop Relat Res 2015 (PMID 24777730) |
| Early, staged, active mobilisation after limb-salvage surgery is safe, no increase in dislocation or infection, associated with better quality of life | Standardisation of rehabilitation after limb salvage surgery for sarcomas improves outcome, Hematol Oncol Stem Cell Ther 2013 (PMID 24161605); occupational therapy rehabilitation after limb salvage surgery, a scoping review, Disabil Rehabil 2021 (PMID 31180732) |
| Weight bearing after distal femoral replacement is typically as tolerated early, with full weight bearing commonly achieved around the third post-operative week; cemented fixation permits faster progression than uncemented | Distal femur resection with endoprosthetic reconstruction, long-term follow-up, Clin Orthop Relat Res 2002 (PMID 12072766); standardised rehabilitation after limb salvage surgery, Hematol Oncol Stem Cell Ther 2013 (PMID 24161605) |
| Extension lag is a common and characteristic problem after distal femoral replacement, attributed to altered quadriceps architecture and leverage after tumour resection | Distal femur resection with endoprosthetic reconstruction, long-term follow-up, Clin Orthop Relat Res 2002 (PMID 12072766); functional outcomes of endoprosthetic reconstruction after tumour resection, Clin Orthop Relat Res 2015 (PMID 24777730) |
| Final knee flexion after distal femoral replacement is usually somewhat less than a native knee | Distal femur resection with endoprosthetic reconstruction, long-term follow-up, Clin Orthop Relat Res 2002 (PMID 12072766); functional outcomes of endoprosthetic reconstruction after tumour resection, Clin Orthop Relat Res 2015 (PMID 24777730) |
| NMES (neuromuscular electrical stimulation) is a reasonable adjunct for quadriceps activation failure during early rehabilitation | Early neuromuscular electrical stimulation to improve quadriceps strength after total knee arthroplasty, Phys Ther 2012 (PMID 22095207), extrapolated to limb salvage rather than studied in it |
| Deep infection is the most significant complication of megaprosthetic reconstruction and is considerably more common than after conventional arthroplasty | Henderson et al., failure mode classification for tumour endoprostheses, J Bone Joint Surg Am 2011 (PMID 21368074); the fate of periprosthetic joint infection following megaprosthesis reconstruction, JB JS Open Access 2021 (PMID 34841189), where 2-year survivorship after infection was 65.1% and mortality 15% |
| Revision surgery is likely at some point over a lifetime with a megaprosthesis; impact loading accelerates wear and is advised against | Survival of megaprostheses in lower limb reconstruction after tumour resection, Clin Orthop Relat Res 2015 (PMID 24964884): overall survival free of further surgery 75.9% at 5 years and 66.2% at 10 years, with failures in 29% of implants |
| MSTS is a clinician-rated 0–100% limb-function score; TESS is a patient-reported measure of everyday task difficulty; good limb-salvage outcomes typically fall in the 70–85% range | Enneking et al., MSTS functional evaluation system, Clin Orthop Relat Res 1993 (PMID 8425352); Davis et al., development of the Toronto Extremity Salvage Score, Qual Life Res 1996 (PMID 8973131); functional outcomes of endoprosthetic reconstruction after tumour resection, Clin Orthop Relat Res 2015 (PMID 24777730) |
| Bone weakened by resection, radiotherapy and chemotherapy carries an elevated periprosthetic fracture risk, including after minor loading | Henderson et al., failure mode classification for tumour endoprostheses, J Bone Joint Surg Am 2011 (PMID 21368074), in which periprosthetic fracture is a recognised failure mode; late complications and survival of endoprosthetic reconstruction, Clin Orthop Relat Res 2010 (PMID 20625951). The added contribution of radiotherapy and chemotherapy to that risk is a clinical concern rather than a quantified finding |
| Long-term surveillance imaging of the tumour site and prosthesis is standard of care for years after sarcoma resection and endoprosthetic reconstruction | Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS clinical practice guidelines, Ann Oncol 2021 (PMID 34303806) |
This guide is general information for patients of Dr Matthew Broadhead (Harbour Orthopaedics & Sports Medicine) and is not a substitute for the specific advice given to you by Dr Broadhead, your physiotherapist or your hospital team.
Surgical findings vary, and your protocol may differ from what is written here: your operation record and your surgeon’s instructions always take precedence.
If in doubt, call the rooms on (02) 9052 1883. In an emergency, call 000.
Last reviewed: 2026-08-05 by Dr Matthew Broadhead, FRACS (Orth).
Fill this in once a week: it shows your trend at a glance and makes reviews far more useful. Bring it to every appointment.
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| Pain score (0–10) | ||||||||||||
| Knee bend (degrees) | ||||||||||||
| Swelling (less / same / more) |
Questions for Dr Broadhead