Limb-sparing surgery for primary bone cancer
Before your operation, your doctor will discuss it with you to make sure that you fully understand what is involved.
Before surgery, your doctor will explain the procedure to you, to make sure you fully understand what’s involved. You can ask questions about how the surgery might affect you. You may find it helpful to talk to someone who has had the same operation. The medical staff or your keyworker may be able to arrange this for you. Some hospitals have a counsellor you can talk to about your feelings and any worries you may have before the operation.
Some people like to see the replacement part or endoprosthesis (often just called a prosthesis) that will be used during their operation. If you would like to see it, your surgeon or keyworker can usually arrange it for you.
A physiotherapist will talk to you before your operation. They may give you some exercises to do before surgery, to help strengthen your muscles.
If you’ve had neoadjuvant chemotherapy, it usually takes a couple of weeks before your blood cell levels get back to normal and you’re ready to have your operation.
At first your limb will be firmly bandaged, or you may have a splint in place to keep it still. This will give the bone graft, or artificial joint or bone, time to start joining firmly on to the rest of the bone in the limb.
You will probably have a drainage tube in the wound, to remove any fluid that collects in the area of the operation. The fluid and blood drains into a small container attached to the other end of the tube. Drains are usually taken out after 3–4 days. You will also have stitches or staples to close the wound. These are usually taken out about 10–14 days after the operation.
Eating and drinking
For the first few hours after your operation you probably won’t feel like eating or drinking much, so you’ll be given fluids as a drip into a vein in your hand or arm (an intravenous infusion). A nurse will take it out once you start eating and drinking again.
After your operation you’ll need painkilling drugs for a few days. These may be given into a vein (intravenously), into the space around your spinal cord (epidural), into a muscle (intramuscularly) or as tablets.
Pain can usually be well-controlled with painkillers. To start with, you will probably need a strong painkiller such as morphine. You may be given intravenous pain relief through a syringe connected to an electronic pump. The pump can be set to give you a continuous dose of painkiller. You may also have a handset with a button you can press if you feel sore. This is called patient-controlled analgesia (PCA). It’s designed so that you can’t have too much painkiller (an overdose), so it’s fine to press it whenever you’re uncomfortable.
If you’ve had surgery on your leg, you may have pain relief using an epidural. A fine tube is put in through your back into the area just outside your spinal cord, called the epidural space. A local anaesthetic can be given continuously into this space to numb the nerves that run to your legs.
Let your nurses and doctors know as soon as possible if you’re in pain. This will help them give you the combination and dose of painkillers that’s right for you.
Physiotherapy is a very important part of your recovery. It helps you regain muscle strength and get good movement back in your limb. A physiotherapist will come to see you soon after your operation and show you some exercises to do. These can be hard work, but it’s important to keep going with them, as they will help you recover.
If you have an operation on your leg or pelvis, you will need to use walking aids such as a frame or elbow crutches to help you move around for some time after the surgery. A physiotherapist will teach you how to get in and out of bed and how to safely use the walking aid to go home.
You may need to continue to have physiotherapy as an outpatient for some time after your operation.
You’ll usually be able to go home once your wound has healed and you can move around safely. For most people this is about 7–10 days after the operation. Most people recover well after their surgery and are able to move around quite soon. Some people take longer to recover and need extra help.
Before you go home, the staff will talk to you about your home situation. If you live alone or have several stairs to climb, you may need some help managing at home. If you have any worries about going home, make sure you discuss them with the nursing staff so they can organise some help.
Living with limb-sparing surgery
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After limb-sparing surgery people are often able to do most of the things they could before, including taking part in exercise and sports. But, depending on which limb was affected, there may be some things you can’t do or that you find more difficult. Your surgeon can explain to you the particular risks of the operation you’re having, how well the limb will work afterwards and the risk of possible complications, such as infection.
When the knee joint is replaced, the new joint normally works very well. It’s fine for you to go swimming or cycling after surgery, but your doctor might advise you against doing high-impact sports like hockey, football, tennis or rugby. This is because of the risk of damaging or loosening the joint.
Some people find that, years after their surgery, their prosthetic knee joint may loosen or cause pain. If this happens, further surgery will be needed.
Replacing a hip joint is usually very successful. Young people will have good strength in the new hip, but older people will usually need to use a walking stick. This is because their joint and muscles may not be as strong as they were before the operation. Hip replacements may also loosen and some people will need to have further surgery within 10 years of having the hip replaced.
People who have a shoulder replacement can normally move their arm around very well below shoulder height. However, they’re usually not able to raise their arm above shoulder height. It’s uncommon for a shoulder joint prosthesis to loosen. These generally last for many years and cause few problems.
With any prosthesis, the main problem that can occur is infection. If the prosthesis gets infected, it will need to be taken out and replaced. The area needs to be cleaned completely with antibiotics before a new replacement joint can be put in.
Where limb-sparing surgery is on a straight part of a bone, it may be replaced by a piece of bone taken from another area of the body. This is known as a bone graft. The main problem that can occur with these operations is an infection in the replacement bone.
Children and teenagers
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If you have a prosthesis put into your limb while you’re still growing, it will need to be lengthened as the leg or arm grows.
Some types of prosthesis are lengthened during further surgery. Other prostheses can be lengthened from outside the limb over a couple of years, to allow for continuing growth. These prostheses are called non-invasive growers. Your specialist or keyworker will explain how your prosthesis will be lengthened. There’s a limit to how much a prosthesis can be lengthened, so younger children will need to have their original prosthesis replaced with a longer one when they’re older.
If you have a bone graft, the limb may not grow normally. In this case, you will need further surgery to keep the limb the same length as the unaffected limb.