Amputation as a treatment for primary bone cancer
It is not always possible to use limb-sparing surgery, and occasionally the surgeon will need to remove (amputate) the limb.
This may be because the cancer has spread from the bone into the surrounding blood vessels. You may also need an amputation after limb-sparing surgery if there’s an infection in the bone that persists despite treatment, or if the cancer comes back in the bone. Very occasionally, after discussion with their specialist doctor and family, people choose to have an amputation instead of limb-sparing surgery.
The preparation for amputation is similar to the preparation for limb-sparing surgery.
You may find it helpful to talk to the rehabilitation team before you come in for surgery. They will answer any questions or concerns about how you will manage after the operation. Psychological support for people who are about to have an amputation is also important. Some hospitals and prosthetic rehabilitation units have a counsellor you can talk to about your feelings and any worries you may have before the operation. It may also help to talk to someone who has had the same operation and can give you practical advice as well as support. The nursing and therapy staff may be able to arrange this for you.
You probably won’t feel like eating or drinking much for the first few hours after your operation, so you’ll be given fluids into a vein in your hand or arm (an intravenous infusion). A nurse will take it out once you begin eating and drinking again.
You may also have an oxygen mask on when you first wake up. Some people will have a tube in their bladder (catheter) to drain urine into a bag until they are up and moving around. The part of your body that has been operated on will be covered with bandages or a plaster cast to control swelling. There will be a tube (drain) coming from your wound to drain off excess blood and fluids into a small container. This will usually be taken out after 3-4 days. You will also have stitches or staples to close the wound, which are usually taken out about 10-14 days after the operation.
You may have some discomfort for a few days after your operation. To start with, you may have morphine through an intravenous patient-controlled analgesia (PCA) pump, or you may have an epidural infusion. It’s important to let the nurses know if you’re still in pain so that they can adjust your painkillers.
After your surgery you may have pain that feels as if it’s coming from the part of the limb that has been amputated. The pain often feels like a cramping, stabbing or burning sensation. It is a type of nerve pain known as phantom pain. You will have some medication at the time of surgery to reduce the risk of this happening. Most people find that phantom pain gets better with time and eventually goes away, but some people find that the pain can affect them long-term.
Other ways of managing phantom pain are acupuncture or graded motor imagery, which includes visualisation techniques and mirror therapy. You can talk to your physiotherapist or occupational therapist about these treatments.
Your doctor can advise you on the best painkillers to take if you have phantom pain. They include painkillers such as morphine, and other medications such as anti-depressants and anti-convulsants that work by reducing nerve pain.
A physiotherapist will visit you the day after your operation. They will show you how to do exercises to keep the muscles around the amputated limb strong and supple, making it easier to work an artificial limb.
The physiotherapist will encourage and help you to move around as soon as possible after the operation. If you’ve had an arm amputated, you will be able to get up and move around once your pain is controlled and you have recovered from the anaesthetic. If you’ve had a leg amputated, your physiotherapist will show you how to move around in bed and transfer to a chair. You’ll probably be moving around with crutches or in a wheelchair within a few days.
Once you’re moving around more, you will go to the hospital gym for physiotherapy. This is a very important part of your recovery. Your physiotherapist will give you different exercises to do as your wound heals and you gain strength.
You will see an occupational therapist soon after your operation. Their aim is to help you become as independent as possible in everyday activities. They may suggest different ways of doing things, or suggest aids or equipment you can use.
They will also work with you to increase your confidence using a wheelchair. If you’re likely to need one for a long time, they will refer you to your local NHS wheelchair service.
If you’ve had an arm amputated, your occupational therapist may teach you techniques to help reduce swelling. They can give you a scar-management treatment programme to start once your wound is fully healed. They will also teach you ways of doing some activities with one hand.
You’ll be able to go home once your wound has healed. If you need physiotherapy after you go home, the physiotherapist will make arrangements for you to have this. If you don’t live close to the hospital where you had your operation, you’ll be able to go to a physiotherapist nearer to you.
You may need some more help at home to support you with certain activities. This may be for a short period of time while you adjust, or for a longer time. Your physiotherapist and nurses will work with you to find out what you need and arrange support for you through social services.
Sometimes people need alterations made to their homes to make it safer for them to move around and to help them be more independent. The occupational therapist will work with social services to arrange these for you if they’re needed.
We have more information about what happens when you're discharged from hospital to home.
Artificial limb (prosthesis)
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Following an amputation, most people are fitted with an artificial limb known as a prosthesis. Modern technology means that artificial limbs are now very effective, enabling people to walk, run and play sport. There are lower limbs adapted for walking, swimming, riding a bike and playing sports, and upper limbs adapted for driving, playing golf and swimming.
One of the team looking after you will discuss limb-fitting with you and explain what’s involved. They will refer you to a prosthetic rehabilitation service.
The earliest you can normally be measured for a prosthesis is about 4–6 weeks after your operation. This usually happens at a prosthetic rehabilitation unit, so you may have to travel to get to one. 1–2 weeks after this, you’ll attend again for a fitting of the prosthesis. If it’s a leg prosthesis, you’ll have physiotherapy to learn how to use it. If it’s an arm prosthesis, you’ll have occupational therapy to learn how to use it.
You will need to feel well enough to cope with prosthetic rehabilitation. If you have chemotherapy or radiotherapy after the amputation, limb-fitting and rehabilitation may need to be delayed.
The staff at the limb-fitting centre will be able to show you the different types of prosthesis and explain how they work. They will talk through your needs, and help you to choose the best types of prosthesis for your situation. For example, if you swim, you may want an additional prosthesis you can wear in water.
The staff at the limb-fitting centre will be able to show you the different types of prosthesis and explain how they work. They will talk through your needs, and help you choose the best types of prosthesis for your situation. For example, if you swim you may want an additional prosthesis that you can wear in water.
Your feelings and emotions
Losing an arm or a leg can feel like a bereavement. You’ll need time to grieve for your loss and to start to cope with the emotional and practical difficulties this type of surgery can bring. These are very strong emotions and you’ll need time and help to come to terms with them. The staff on the ward will know this and will help you as much as they can.
Either before or after your operation, you may find it helpful to talk to someone who has had an amputation. The doctor or nurses on your ward may be able to arrange this.
Even if you thought you had a good idea of what to expect before surgery, you may still feel shocked and distressed after the operation, when the full realisation of having lost an arm or leg hits you. You will be used to what your body looks like, and it can be very difficult to come to terms with a major change such as an amputation.
The sense of looking different from other people can affect your self-confidence. You may find it useful to read our information about body image and cancer.
Family and friends
Your partner, family and friends may also find it hard to come to terms with their feelings about your amputation. You may be anxious about what they will say or think, and whether you will be able to cope with their reactions. This worry can feel very real, but most people find their families and friends want to do as much as possible to support them. It can help to be open about your feelings and any fears about people’s reactions.
Other people’s reactions
As you become more used to the way you look, you will become more confident about dealing with the reactions of people you don’t know as well. Some people find it helpful to get out and about as soon as possible after the operation, while others may take longer. It’s important to do things in your own time. You may want to take someone with you at first to offer support. You may find that other people don’t even notice your amputation, especially if you’re wearing an artificial limb.
You may feel unattractive and embarrassed about your body, and worry that no one will find you sexually attractive again. Meeting a new partner may seem particularly daunting. If you have a partner, you may be concerned that they won’t find you attractive any more.
We discuss these issues in our information on relationships, sexuality and cancer.
Call our cancer support specialists for details of support groups or counselling services in your area. Support groups can give you both practical and emotional advice. They can also help stop you feeling like you have to cope alone.