Limb-sparing surgery

Before your operation, your doctor and the nurses on the ward will discuss it with you to make sure that you fully understand what it involves. It is often helpful to talk to someone who has had the same operation you are going to have, and the medical staff will be able to arrange this for you. On some wards a special counsellor may be available to discuss any worries you may have.

Some people like to see the prosthesis (replacement part) that will be used during their operation and the staff can also arrange this for you. A physiotherapist will talk to you before your operation and may give you some exercises to help strengthen your muscles.

If you have had chemotherapy|, your body will need some time to recover before surgery can be done. Usually it takes a couple of weeks before the level of blood cells in your blood go back to normal and you are ready to have your operation.

After 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.

Drips and drains

A drip will give fluids into a vein in your arm until you are able to eat and drink properly. The drip will then be removed by the nurses on the ward. You will probably have a drainage tube from the wound in place for 3–4 days.

Pain

It is likely that you will have some pain and discomfort after your operation, and painkillers will be prescribed for you. To start with you will probably need a strong painkiller such as morphine. This will be given to you in one of two ways: as injections (given by the nurses); or through a small pump, attached to a needle in your arm, which releases the drug as you need it (you can give extra doses yourself).

It is important to let the nurses know if your painkillers don’t seem to be working.

For people who have had surgery on their leg, a different method of pain relief, called an epidural, may be available. For this method, your doctor injects a local anaesthetic into the epidural space around the spine, in your lower back, to numb the nerves which run to your legs.

Physiotherapy

A physiotherapist will visit you shortly after the operation and show you some exercises to do in bed. These exercises keep the muscles in the limb strong and supple, so that as soon as it is strong enough, you can use it normally.

If you have had surgery to your leg, you will probably be left with a slight limp. Sometimes trying to walk normally with a limp puts pressure on the leg and causes pain elsewhere in the body. Although it is important to have any continuing pain checked by your doctor, it does not necessarily mean that the cancer has come back.

Going home

Most people are able to go home once their wound is well healed, usually within a week to 10 days after their operation. If you think that you will have problems when you go home (for example if you live alone or have several flights of stairs to climb) let your nurse or the social worker know when you are admitted to the ward. They can arrange help before you leave hospital.

Some people take longer than others to recover from their operation. If you have any problems, you may find it helpful to talk to someone who is not directly involved with your illness.

Our cancer support specialists| are always happy to talk to you and can tell you how to contact a counsellor or a local cancer support group.

Living with limb-sparing surgery

Many different types of limb-sparing surgery can be carried out. The most common type uses a metal replacement part to replace the piece of bone that has been removed. The metal replacement part is called an endoprosthesis. The most commonly replaced joint is the knee joint. The next most common are the hip joint and then the shoulder joint. The benefits and possible problems of limb-sparing surgery are described below.

Knee joint

When the knee joint is replaced, the new joint normally works very well. People who have had this operation can swim or take part in activities such as walking, but should not run or play contact sports due to the risk of damaging or loosening the prosthesis. In some people the endoprosthesis may work loose or cause pain and may need to be replaced after a few years. Around 25% of people (1 in 4) who have a knee prosthesis will need to have a further operation within 10 years of having the knee replacement.

Hip joint

Replacement of the hip joint is usually very successful. Young people will have good strength in the hip, but older people 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 around 10% of people (1 in 10) will need to have a further operation within 10 years of having the hip replaced.

Shoulder joint

People who have shoulder replacements can normally move their arms around very well below shoulder height. However, they are usually not able to raise their arms above shoulder height. It is uncommon for shoulder joint prostheses to loosen. These generally last for many years after the operation 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.

Bone grafts

Limb-sparing surgery on a straight part of the bone may replace the bone that has been removed with bone taken from other areas of the body. This is known as a bone graft. The main problem with these operations is infection of the replacement bone. Your surgeon will be able to give you detailed advice about the particular risks of the operation you are to have, how well the limb will work afterwards and the risk of complications such as infection.

Children and teenagers

If a prosthesis has been put into the limb of a child or teenager, 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 the need for surgery. Your child’s specialist or nurse will explain how the prosthesis will be lengthened. If a bone graft is taken from a limb, that may also mean that the limb does not grow normally and so further surgery may be needed to keep the limb at the same length as the unaffected limb.