Amputation as a treatment for primary bone cancer
It is not always possible to use limb-sparing surgery and occasionally removing (amputating) the whole limb may be necessary.
This is often because the cancer has spread from the bone into the surrounding blood vessels. An amputation may also be needed 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.
The preparation for amputation is similar to that for limb-sparing surgery. You should also be given psychological support before and after the operation, as facing an amputation can feel overwhelming.
The medical staff looking after you will be able to offer help and support. It may also be helpful to talk to someone who has had the same operation and can give you practical advice and encouragement. The hospital staff may be able to arrange this for you. You may also find it useful to speak to another support organisation.
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. This is called a drip or 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 be given morphine by an intravenous 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 and is a form of nerve pain known as phantom pain. Most people find that phantom pain gets better with time and eventually goes away, but some people find that the pain can persist long-term.
There are a number of different types of drug that can be given to relieve phantom pain. They include painkillers such as morphine, and other medications such as antidepressants and anticonvulsants that work by reducing nerve pain. Your doctor will be able to advise you on the best painkillers to take if you have phantom pain.
A physiotherapist will visit you a day or so 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.
You will be encouraged and helped 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. If you’re going to be fitted with an artificial limb you’ll also be taught how to use this to help you regain independence in everyday activities.
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 aids or equipment that you can use.
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.
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. Many different types of artificial limb are available. There are lower limbs adapted for walking, swimming, riding a bike and playing sports, and upper limbs adapted for playing golf, swimming and so on.
One of the team looking after you will discuss limb-fitting with you and explain what’s involved. The remaining part of your amputated limb will take a few months to shrink to its final size and shape, so you won’t be measured and fitted with a permanent prosthesis until this happens.
In the meantime, if you’ve lost a lower limb you’ll normally be measured and have a fitting for a temporary prosthesis about 4-6 weeks after your operation. This usually happens at a limb-fitting centre, so you may have to travel to get to one. About two weeks after this you’ll get your temporary prosthesis and be ready to learn how to use it in physiotherapy. About six months after surgery you’ll be fitted with a long-term prosthesis. The timing varies from person to person.
People who’ve lost an upper limb don’t have a temporary prosthesis. They are usually ready to be fitted with a long-term prosthesis about three months after their operation.
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 over 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 that you can wear in water.
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.
You may find it helpful, either before or after your operation, 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 were prepared for losing a limb, you may still feel shocked and distressed after the operation. You’ll be used to what your body looks like and it can be hard to come to terms with such a major change. The sense of looking different from other people can seriously affect your self-confidence and make you afraid of how other people might react.
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. They can also make suggestions to help you cope with people’s reactions.
Other people’s reactions
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You may be frightened of other people’s responses to your amputation. You may feel worried about what your partner, family or friends will say or think, and whether you’ll be able to cope with their reactions.
Although this fear is very real, it’s often worse than the reality. Try to focus on the fact that the people who love you do so because of who you are and not how you look. The qualities you are loved for are not removed by an amputation. Be open about your fears. Given the chance, most people will be very keen to reassure you that they still love you.
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 also 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 are wearing an artificial limb.
You may feel different about yourself sexually and worry that you aren’t as sexually attractive. This can be distressing no matter what your age and whether you have a partner or not. Many people find it helpful to discuss their feelings with their partner, a close friend or counsellor.
We have more 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 both practical and emotional advice and help to stop you feeling as if you have to cope alone.