Mr Mahaveer.H 50/Male was diagnosed with a form of cancer called chondrosarcoma of the thigh (Femur) bone close to hip. Chondrosarcomas are a heterogeneous group of malignant bone tumors. The second most common bone malignancy affecting adults. Initial assessment and diagnosis with X RAY, MRI, HRCT & Bone Biopsy was confirmed with no spread to other parts of body. It’s a very large large tumor approximate size of Football 16x20 cm was growing to present sixe over four years .Impairing the daily activities & was unable to walk without support.
This cancer is not responsive to chemotherapy or radiation. Surgery is the only treatment option, which, in 90 percent of cases, results in a amputation of the leg and part of the hip. There was only a 10 percent chance his leg would be saved.
The incredible efforts of a team of surgeons who operated for more than 8 intense hours, SAVED THE LIMB!!.Instead of amputating the leg with a large tumor of thigh bone.
Dr. Vivek S. Patil MS, Joint Replacement Surgeon & Surgical team, comprised of, Oncho Surgeon ,Orthopaedic and Anaesthetic experts, saved the entire limb at KLES Dr. Prabhakar Kore Hospital. The patient was able to walk with assistance two weeks after surgery.
The operative procedure consisted of three phases: tumor resection, skeletal reconstruction and soft tissue reconstruction. During the operation, the team freed the tumor embedded adjacent to critical structures such as the nerves and blood vessels. and salvaged the leg.
A limb-sparing radical resection of the proximal femur performed for a large chondrosarcoma, followed by reconstruction with a modular, segmental, proximal-femur tumor prosthesis. The chondrosarcoma infiltrated the head and greater trochanter of the femur, as well as the proximal shaft. Additionally, it demonstrated cortical breakthrough with a moderately sized extraosseous soft tissue component. The surgical procedure was done with strong emphasis on dissection and mobilization of the sciatic nerve. We further emphasize multiple muscle attachments , which are used to allow optimal function and to cover the prosthesis with soft tissue to minimize complications.
A customized prosthetic reconstruction with a metallic, modular, segmental tumor prosthesis & the leg muscle was then reconstructed and attached to the prosthesis.
Mr. Mahaveer “ I am able to walk again, the loss of ambulation may have led to depression and a strain on the family, will be able to walk again and return to his regular activities . For me, there is nothing better.”
The technological advancement that improved the results of limb salvage surgery was the development of better reconstructive options. Allograft techniques improved during time , and modular prosthetic replacements were developed. In addition, a combination of implants and allografts were tried with success. All of this has led to limb salvage surgery with better functional outcome and fewer complications. Neoadjuvant chemotherapy was developed—the delivery of cytotoxic drugs prior to removal of the tumor, which leads to tumor necrosis and better oncologic outcomes. When used prior to limb salvage surgery for osteosarcoma, such drugs have been shown not only to improve patient survival, but also to reduce the risk of local recurrence to a level comparable to that for amputation. Compared survival data for limb salvage surgery to that for amputation and found comparable results. This further increased the enthusiasm for limb-preserving techniques, particularly because surgeons realized that patient survival would not be jeopardized.
The prosthesis is either a one-piece design or a more recent, modular system, which allows intraoperative customization of length. This makes some intraoperative flexibility possible, as does an allograft prosthesis composite. The fixation stems can vary in length and diameter, and they can be straight or bowed to accommodate whatever remains of the patients’ femur. These prostheses are generally cemented in place, although noncemented designs have shown effectiveness as well. Once the prosthesis is in place, soft-tissue reconstruction is critical in minimizing complications and improving function.