Physical therapy protocols for patients with a megaprosthesis after bone tumor resection

PURPOSE: To provide evidence-based guidance for physical therapists in the treatment of patients after surgical resection of bone tumors and reconstruction with megaprostheses. MATERIALS AND METHODS: We performed an explorative literature search and organized a consensus procedure with three orthopedic oncologic surgeons and three physical therapists. The first version of physical therapy protocols was drafted, and the protocols were used for 1 year in patient care. After 1 year of piloting, a second consensus procedure was performed and the protocols were adjusted according to the findings in clinical care and new findings in the literature. Finally, the protocols were implemented in patient care. RESULTS: Physical therapy protocols were developed for six different megaprostheses: internal hemipelvectomy and reconstruction with a pedestal cup endoprosthesis, proximal femur resection, distal femur resection, total femur resection and reconstruction with a megaprosthesis, proximal tibia resection and reconstruction with an allograft and a megaprosthesis, and proximal humerus resection and reconstruction with a reverse shoulder megaprosthesis. The protocols can be used in patient care for adult patients undergoing resection of bone tumors and reconstruction with megaprostheses. CONCLUSIONS: These practical protocols, including goals, exercise therapy, and points for attention, provide guidance to physical therapists treating patients after surgical resection of bone tumors and reconstruction with megaprostheses.