Orthopedic Oncology  

In many instances, it is feasible to remove an extremity tumor using limb-salvage surgery, wherein the tumor is removed without the need for amputation, sparing the affected arm or leg. The main purpose of limb-salvage surgery is to properly remove the tumor while maintaining important anatomic structures like nerves and blood vessels. This highly specialized surgical approach can be utilized in most cases of bone and soft-tissue tumors. 

After successfully removing the tumor, our goal is to reconstruct the limb and restore limb function to the greatest extent possible. This is often achieved by utilizing metallic internal prostheses, allograft bone (cadaveric) or allograft-prosthetic composites. Soft tissue reconstruction may involve the use of skin grafts, free vascularized muscle flaps or composite flaps. In rare cases, blood vessels and nerves that are involved in the tumor must be removed and subsequently reconstructed. 

Limb-salvage surgery is frequently combined with other treatments like radiation therapy, systemic chemotherapy, physical therapy, palliative care and/or pain management. Treatment plans ultimately depend on many patient-specific and tumor-specific factors. Every patient’s care plan is customized, with the goal of maximizing an individual’s oncologic and functional outcomes.

For children, removing a tumor in or around a major joint can be particularly challenging, as it frequently requires removing one or more growth plates. As a result, the child’s growth is impacted, with the affected limb expected to grow less than the opposite side. In the past, a child would undergo multiple major surgeries to adjust the implant as they continued to grow. Today, it is possible to use a growing implant, which extends or lengthens over time. This permits a child’s limb to keep up with the opposite side, maintaining anatomic symmetry and providing obvious benefits in functionality, comfort and aesthetics for the patient. 

Growing implants can be minimally invasive or noninvasive. A minimally invasive implant requires a minor surgical procedure for each lengthening, during which one or two small incisions are needed. Surgeons introduce small surgical screwdrivers through the incisions. By rotating these drivers, the implant lengthens. After an acceptable length has been achieved, the incisions are closed and the patient is awakened from anesthesia. The patient can immediately walk on the implant and often go home the same day with minimal discomfort, which usually resolves in one to two days. 

A noninvasive growing implant does not require additional surgery or anesthesia. Instead, these implants are lengthened internally using a magnet to rotate a gearbox inside the implant. The patient can remain awake during this process with minimal to no discomfort. The lengthening is performed in-office and takes roughly 15 to 20 minutes. The patient can walk on the implant immediately and go home directly following the lengthening. 

Growing implants represent patient-specific and leading-edge orthopedic implant technology. These implants are reserved for a small group of pediatric patients with unique reconstructive challenges owing to their continued growth potential. This individualized reconstructive method eliminates the need for amputation or other more ablative surgeries, allowing the restoration of routine function in a majority of patients.

Custom joint replacement implants are used to rebuild or reconstruct a patient’s joint following surgical resection of a tumor in or adjacent to a major joint. While standard joint replacement implants can often be employed successfully, in some instances custom-designed implants may be a better solution. Tumor size, tumor location, remaining bone stock or other patient-specific considerations determine which implant is appropriate. 

Each custom implant is patient-specific, designed to match a patient’s size, anatomy and reconstructive needs. Implants are designed and manufactured by select orthopedic implant companies using cutting-edge technology. During the design process, surgeons work closely with engineers and other specialists to ensure the implant fits the anticipated surgical plan and meets all related engineering and manufacturing standards. 

Custom implants are reserved for a small group of patients with unique surgical and reconstructive challenges. This individualized reconstructive method eliminates the need for amputation, allowing the restoration of routine function in a majority of patients.

Navigation-guided surgery, also referred to as image-guided or computer-assisted surgery, uses imaging modalities, such as a computed tomography (CT) scan, to increase the accuracy of a procedure. This technology tracks the position and movements of surgical instruments, linking them to an imaging study in real time, which allows the surgeon to make very small, specific corrections. 

While not necessary in every procedure, navigation-guided surgery serves as a valuable surgical tool for treating select patients with tumors located in the pelvis or spine. This treatment can maximize surgical accuracy, aid reconstructive fit or fixation and improve patient outcomes.

Allograft bone can be used to rebuild or reconstruct a patient’s limb following surgical removal of a tumor. While joint replacement surgery can often be used successfully, there are instances when using cadaveric structural bone is a feasible alternative. For example, some tumors involve the central portion of a long bone, and treatment does not require joint replacement. In such cases, reconstruction can be achieved with an intercalary allograft bone. Once healed, this can offer excellent functional outcomes. 

Allograft bones are carefully screened and selected from accredited and reputable bone banks. The bone is sized to closely match a patient’s anatomy and address their individual needs as best as possible. This treatment is an excellent example of personalized surgical planning, tailored to a patient and their individual reconstructive needs.