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Orthopedic oncology

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on October 27, 2021.

Orthopedic oncology involves the diagnosis and treatment of malignant disorders of the musculoskeletal system. Orthopedic oncologists treat conditions such as:

At Cancer Treatment Centers of America (CTCA), our orthopedic oncologists have expertise in diagnosing and treating malignant musculoskeletal diseases. Orthopedic oncologists perform a variety of procedures to remove tumors, reconstruct the bones, if necessary, and help patients restore mobility and/or relieve symptoms.

Bone cancer and sarcoma may require a combination of treatments and therapies. An orthopedic oncologist may use targeted procedures to remove tumors or reconstruct bone. These treatments and therapies are also designed to help restore limb mobility, enhance function and manage pain.

Procedures an orthopedic oncologist may perform include:

Amputation

Amputation is the surgical removal of all or part of an extremity or limb. This surgical procedure may be used to remove cancerous bone tumors from the arm or leg; however, doctors typically consider other options first, such as limb-salvage surgery, which attempts to save the affected limb.

Amputation for bone cancer is usually reserved for cases in which the limb would otherwise be left without good function. When amputation is used to treat cancer, your doctor removes the limb with the tumor as well as healthy tissue above it. During the surgery, a pathologist will use magnetic resonance imaging (MRI) scans to examine the tissue to help decide how much of the limb needs to be removed. Muscles and skin will be formed around the remaining bone so that an artificial limb can be used.

Hip replacement

A hip replacement, or arthroplasty, is a surgery performed to remove a diseased or damaged hip joint and replace it with an artificial joint. Conditions such as osteoarthritis, rheumatoid arthritis and osteonecrosis, as well as bone tumors, fractures or injuries, are common causes of hip joint damage. Patients who have cancer that has spread to and damaged the hip joint may be candidates for hip replacement surgery.

Kyphoplasty/vertebroplasty

A minimally invasive procedure, kyphoplasty/vertebroplasty is often used to treat compression fractures of the spinal vertebrae. In this procedure, a special balloon is inflated inside the fractured bone to expand it to its normal height. The balloon is then deflated and removed. Using image guidance, a cement-like material is injected directly into the remaining space through a hollow needle. The material, considered to be as strong as bone, doesn’t injure normal bone tissue. This procedure may help to relieve pain, restore height and mobility, reduce spinal deformity and stabilize fractures in patients with vertebral compression fractures caused by their cancer spread. Among the cancers that are most likely to spread to the bones are prostate and breast cancers. Cancers that may cause spinal vertebral fractures also include multiple myeloma and lung cancer.

Limb salvage surgery

Limb salvage surgery, also called limb-sparing surgery, is a procedure intended to remove a tumor while still preserving the nearby tendons, nerves and blood vessels so the patient can maintain function in the affected limb. During the procedure, the surgeon removes the tumor and affected tissue, as well as about 1 inch of healthy surrounding tissue. If part of a bone is removed during this time, it is replaced, often using synthetic metal rods, prostheses or pieces of bone (grafts). Soft tissue and muscle from other parts of the body are then used to close the wound. Over time, the replacement bone fuses with the original bone, making limb movement possible. Limb salvage surgery is often used in conjunction with radiation therapy and/or chemotherapy. It may be an option to treat cancer that is spreading at a slow rate.

Orthopedic implants

Patients with primary bone cancers may require orthopedic implants, which are devices that replace or support damaged joints or bones in the body. Pins, rods, screws and plates are the most common implants. Metal rods may be used to prevent bones from breaking. Orthopedic implants are made of plastic, ceramic, stainless steel and titanium. Orthopedic implants may be used to treat joint degeneration in the hip, knee, shoulder and elbow. Implants may restore normal function by increasing mobility and reducing pain.

Surgery is required to secure the implant where it’s needed. Non-surgical methods are often the first line of treatment. Implants are used when non-surgical methods, such as weight loss and physical therapy, do not work. Orthopedic implants wear out after several years, so implants in younger patients may need to be replaced.

Other procedures

Other procedures performed by an orthopedic oncologist may include:

Soft tissue excisions/resections

The most common treatment for adult soft tissue sarcoma is surgery to remove (excise) the tissue or resection it.

Surgery also may be recommended if the soft tissue sarcoma has recurred in the same area or if you have metastatic disease.

Often, the surgery requires a wide excision of the tumor, meaning the tumor is removed as well as a good bit of healthy tissue all around it. If your orthopedic oncologist is able to remove the tumor and the tissue surrounding it, you may not need any other treatment.

Amputation

If you have osteosarcoma, a tumor in an arm or leg, you may need to have your limb amputated. Amputation may be the best option if the tumor is large or has grown into or around nerves or blood vessels. Your surgeon will plan the surgery to spare as much remaining muscle and skin around the bone so that you can be fit for a prosthesis.

Reconstructive surgery

If you need an amputation due to cancer, your surgeon may design the surgery so the limb can be reconstructed. An example: Your leg must be amputated at the middle of your thigh because of a tumor. The surgeon may be able to reattach your lower leg and foot to your thigh bone. Your ankle is now your knee joint. You would still need a prosthetic limb to replace the part of the leg that was amputated. This type of surgery is called rotationplasty. After about three to six months, and with physical therapy, you should be able to walk on your own.

While surgical techniques have improved dramatically in recent years, most who undergo limb-sparing surgery will need reconstructive surgery to be able to use their limb again.

Palliative surgery (to relieve symptoms)

Palliative care is meant to improve how you feel while you’re managing your orthopedic cancer. Surgery may be recommended as part of your palliative care. If your bone cancer has spread to other parts of your body, your team may recommend surgery to remove the metastases and allow you to feel better.

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