BACKGROUND: Despite advances in limb-salvage surgery in orthopaedic oncology, the effect of ethnicity and sex on patient function recovery remains unclear. Our study examined the influence of sex and ethnicity on functional outcomes for patients with bone tumors undergoing lower extremity endoprosthetic reconstruction.
METHODS: This study was a secondary analysis of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial. Functional outcomes were assessed preoperatively and at 3, 6, and 12 months postoperatively using the Musculoskeletal Tumor Society 1993 (MSTS-93) and Toronto Extremity Salvage Score questionnaires. Delta scores (postoperative minus preoperative) and minimal clinically important difference thresholds were calculated by ethnicity and sex, and group differences were analyzed.
RESULTS: Among the 604 patients included, the main ethnic groups were White (63.6%), Asian (18.7%), Black (7.1%), Hispanic (5.6%), and Other (5%). Asian patients had markedly higher preoperative and postoperative MSTS-93 and TESS scores than other groups, although delta scores were similar across all ethnicities. Although MCID achievement rates for MSTS-93 did not differ by ethnicity, Asian patients showed a higher MCID achievement rate for TESS at 3 and 6 months. Sex-based analyses revealed that men had higher baseline functional scores, but women demonstrated greater postoperative improvements, as reflected by higher delta scores. Although postoperative MSTS-93 MCID achievement rates were similar between sexes, women exhibited higher TESS MCID achievement across all postoperative timepoints.
CONCLUSION: Asian patients had higher functional outcomes after endoprosthetic reconstruction, and ethnic minorities did not show worse outcomes than White patients. Additional research should explore these trends in different settings.
LEVEL OF EVIDENCE: I.
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