Long-term exercise-based rehabilitation after limb-salvage surgery for lower-extremity dedifferentiated liposarcoma: a case report

Background Limb-salvage surgery (LSS) for lower-extremity dedifferentiated liposarcoma (DDLPS) often leads to persistent functional deficits, impaired balance, and gait asymmetry due to extensive muscle resection. Evidence regarding long-term exercise-based rehabilitation (ExR) in this population remains scarce. Methods A 68-year-old woman, 19 months post-LSS, completed an 18-month supervised ExR program integrating resistance, endurance, gait, and balance training. Assessments were performed at baseline (T0), 9 months (T1), and 18 months (T2). Clinical assessments included the 6-Minute Walk Test (6MWT), Mini-Balance Evaluation Systems Test (Mini-BESTest), Falls Efficacy Scale–International (FES-I), and Toronto Extremity Salvage Score (TESS). Instrumental evaluations comprised kinematic gait analysis during normal walking (NW) and fast walking (FW) using an inertial sensor, and physical activity monitoring via a tri-axial accelerometer. Results Post-intervention, positive trends were observed across all outcomes. NW gait speed increased by 0.40 m/s and 6MWT distance by 97 m, exceeding minimal clinically important differences. Step-length symmetry ratio (operated/non-operated limb) normalized in NW (1.16 at T0 vs. 0.98 at T2) and FW (1.13 vs. 1.00), while gait symmetry index increased from 85.0% to 94.7% in NW and 88.0% to 97.2% in FW. Mini-BESTest score (16 vs. 25), FES-I score (40 vs. 21), and TESS (62.7% vs. 100%) showed marked improvements. Daily steps increased from 3,534 to 6,757, while sitting time decreased from 459 to 318 min/day. Conclusion The single-patient design and absence of a control condition prevent directly attributing the observed improvements to the rehabilitation program. However, these promising preliminary observations suggest that prolonged, individualized ExR may help target long-term deficits after LSS, warranting further investigation in larger prospective controlled cohorts.