Quality of Life after Rotationplasty for Lower Extremity Sarcoma: A Systematic Review and Meta-analysis

Rotationplasty is a reconstructive option for lower extremity sarcomas; however, concerns about cosmetic appearance and presumed psychosocial impact continue to limit its use. Although quality of life is increasingly recognized as an important outcome in orthopaedic oncology, the independent effect of rotationplasty on patient-reported quality of life has not been systematically evaluated. This study aimed to synthesize available evidence on quality-of-life outcomes following rotationplasty. A systematic review and meta-analysis were conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251131148). MEDLINE and Embase were searched for studies reporting quality-of-life outcomes in patients treated with rotationplasty, with or without comparison to limb salvage surgery, amputation, or healthy controls. Methodological quality was assessed using Joanna Briggs Institute checklists, and random-effects meta-analyses were performed to calculate pooled mean differences (MD) with 95% confidence intervals for SF-36 outcomes. Sixteen studies, including 299 patients, were analyzed. Compared with healthy controls, rotationplasty was associated with lower Physical Functioning (MD −11.4; p < 0.05) and Role Physical scores (MD −8.6; p < 0.05), but higher Vitality (MD 6.0; p < 0.01) and Mental Health (MD 10.5; p < 0.01) scores. Compared with amputation, Physical (MD 6.5; p < 0.001) and Mental Component Summary scores (MD 4.9; p < 0.01) were higher, while Physical Component Summary scores were also higher versus limb salvage surgery (MD 6.5; p < 0.01). Toronto Extremity Salvage Scores indicated high functional capacity. Rotationplasty yields quality-of-life outcomes comparable to healthy populations and, in several domains, superior to alternatives, supporting its role as reconstructive option.