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 that you fully understand what is involved. You will be given the opportunity to ask any questions you may have 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 key worker 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 do this, your surgeon or key worker can usually arrange it for you.
A physiotherapist will talk to you before your operation and 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 or so 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 onto the rest of the bone in the limb. You will probably also have a tube (drain) coming out of your wound. This will drain excess fluid and blood 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 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 will have some pain and discomfort after your operation, which will be controlled with painkilling drugs. To start with, you’ll probably need a strong painkiller such as morphine. Morphine may be given to you as tablets, as injections into a muscle given by the nurses, or through a special pump known as a patient controlled analgesia pump (PCA pump). If you have a PCA pump it will be attached to a fine tube (cannula), which is placed in a vein in your arm. You can control the pump yourself using a handset that you press when you need more of the painkiller. It’s fine to press the handset whenever you have pain, as the pump is designed so that you can’t give yourself too much painkiller. If you find you need to press the handset a lot, tell the nurses in case you need a higher dose. You will be shown how to use this type of pump.
Some people may have a different method of pain relief called an epidural infusion. A fine tube is inserted through your back into the area just outside the membranes around your spinal cord, called the epidural space. A local anaesthetic and other painkilling drugs are given by infusion (drip) into this space using an electronic pump. The anaesthetic drugs work by numbing the nerves in the operation area and reducing pain.
It’s important to let the nurses know if your painkillers don’t seem to be working so that they can either increase the dose or put you on a different painkiller.
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 exercises keep the muscles in the limb strong and supple, so that as soon as it’s strong enough you can use it normally.
Once you’re able to get up and around, the physiotherapist will give you more exercises to do. These can be hard work, but it’s important to keep going with them as they will help you recover. 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 to manage at home. If you have any worries about going home, make sure you discuss them with the nursing staff so that help can be organised.
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.
Replacement of the 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, while other types can be lengthened without needing an operation. Your specialist or key worker will explain how the 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 a bone graft is used, this may also mean that the limb doesn’t grow normally and so further surgery may be needed to keep the limb the same length as the unaffected limb.