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LIMB PRESERVING SURGERY
Bone tumors develop as a result of uncontrolled growth of cells in bones. Most common types include Osteosarcomas in adolescents, Ewing’s sarcomas in young children and Chondrosarcomas in adults. The most common site of origin are bones of the lower limb around the knee joint and upper arm. Most of these tumors are benign (not cancerous) and are not life threatening as they do not spread to other parts of the body. Some tumors are however cancerous and spread to other parts of the body. The diagnosis of bone sarcoma is confirmed with a bone biopsy and MRI to assess local extent. Most patients need multimodality approach with the correct sequence of surgery, chemotherapy and radiotherapy.
Currently most bone sarcomas can undergo surgical resection with limb salvage surgery i.e. no need for amputation of the limb. This procedure involves resection of the part of the bone with tumor with replacement of the bone with a modular prosthesis which allows for normal mobility at the affected joint.
Recently we received a query from a 21 year old gentleman from Sudan, who had a tumor in lower end of femur (Osteoclastoma) for which he was operated twice at his native place. Subsequently he developed recurrence leading to swelling over his left knee joint and was unable to walk. He was advised above knee amputation at local hospital in his country. After reviewing his reports, we advised him to follow up with us and offered him the possibility of limb preserving surgery. He presented to us in a wheel chair with a round knee joint and severe pain. After evaluating him and discussing his case in multidisciplinary tumor board, he was planned for limb salvage surgery and modular prosthesis implant. After detailed discussion with the patient and his relatives regarding the extent of surgery and various modalities of reconstruction option, he underwent Limb salvage surgery i.e. removal of bone tumor with a segment of normal bone and adjacent soft tissue and replacement by a modular hinge prosthesis and muscle flap cover over the implant. He responded well to treatment and had an uneventful recovery. The patient underwent intensive physiotherapy which continued post discharge from hospital and gradually he was allowed weight bearing on his operated leg. Later on he could walk without any support.
The final biopsy report was favourable and he didn’t require any further treatment. The physical burden of undergoing an amputation of limb along with the psychological effect associated with it is a traumatic experience for most people. Nonetheless with the advancement in technology and surgical techniques, we are able to offer limb preservation in majority of patient suffering from bone tumors. General awareness and multi-speciality team approach is essential for dealing such cases to achieve superior result.