Factors influencing imaging and functional recovery outcomes after limb-salvage surgery in patients with bone tumors: a retrospective case-control study.

BACKGROUND: Limb-salvage surgery is the preferred treatment for primary bone tumors, yet postoperative imaging and functional outcomes remain variable. This study aims to identify factors affecting postoperative imaging and functional recovery outcomes in patients undergoing limb-salvage surgery for primary bone tumors. METHODS: A retrospective case-control study was conducted on 231 adult patients with primary bone tumors who underwent limb-salvage surgery at a single institution between January 2016 and January 2024. Patients were categorized into favorable and adverse outcome groups based on postoperative imaging, local recurrence, and Musculoskeletal Tumor Society scores. Data were collected on demographics, tumor characteristics, surgical methods, nutritional status, adjuvant treatments, supportive care, and complications. Univariate and multivariate logistic regression analyses were performed to identify factors independently associated with favorable outcomes. RESULTS: Significant differences were found between outcome groups in age, lymphocyte count, preoperative chemotherapy, tumor margin clarity, tumor size, resection method, adjuvant treatment, rehabilitation, and infection rates. Patients with favorable outcomes were younger, had higher lymphocyte counts and albumin levels, received more preoperative chemotherapy and adjuvant treatments, displayed clearer tumor margins, underwent wide resection more often, had smaller tumors, and participated more in rehabilitation. The adverse group had higher rates of infection and marginal resections. No significant differences were observed in tumor type, location, reconstruction method, prealbumin and hemoglobin levels, or rates of pain management, psychological support, delayed wound healing, joint stiffness, or muscle atrophy. Multivariate analysis identified younger age, wide resection, and adjuvant treatment as independent predictors of favorable imaging and functional recovery. CONCLUSION: Younger age, wide surgical resection, and receipt of adjuvant treatment independently predict improved postoperative imaging and functional outcomes following limb-salvage surgery for primary bone tumors. Optimizing perioperative management and surgical strategies may enhance patient recovery and long-term outcomes.