A multidisciplinary approach is used to diagnose and treat adults and children with benign, malignant, and metastatic disease of the musculoskeletal system. This includes benign bone tumors such as osteochondromas and other cartilage tumors, bone cysts, and giant cell tumor and benign soft tissues, such as lipomas, vascular tumors, and nerve sheath tumors. Malignant bone and soft tissue tumors such as osteosarcoma, Ewing’s sarcoma, chondrosarcoma and all soft tissue sarcomas in all anatomic sites of the upper and lower extremities, pelvis, spine and sacrum are also treated. Complex sacral tumors, such as cordoma are treated usually with a multidisciplinary approach, including spine surgeons and colorectal surgeons to maximize the oncologic and functional results.
A specially trained orthopaedic oncologist works closely with numerous other subspecialties, including radiologists, pathologists, adult and pediatric oncologists and radiation oncologists, to create an individual treatment plan that aggressively treats the cancer while ensuring the highest quality of life for the patient. From a surgical standpoint, the goal is to completely remove the tumor, while persevering and maximized extremity ability and function. For benign lesions we are able to do this in nearly all patients and generally achieve a normal extremity. In patients with primary malignancy of the extremity we are able to avoid amputation in a majority of patients because of our extensive experience in limb salvage techniques. Specific surgical techniques used in reconstructing a limb after tumor removal includes:
- Metallic endoprosthetic and metallic endoprosthetic bone and joint reconstruction
- Large fragment allograft reconstruction
- Vascularized fibular graft reconstruction
- For tumors in the growing child: expandable endoprosthetic implants are available to deal with the potential growth discrepancy between the operated and non-operated limb.
Rotation-plasty is another technique that is available in the growing child as well. This is a technique where after the removal off a large segment of the thigh and knee the lower leg and ankle can be transposed and rotated such that the ankle becomes a new knee. Functional result after prosthetic fitting is generally excellent. In the event that formal amputation is required to control the tumor we have the skill and experience necessary to perform these procedures safely and effectively, including amputations around the limb girdle such as Hemipelvectomy and forequarter amputation.
Metastatic disease of the skeleton is also managed by our multi-disciplinary team. When cancer originating in other organ systems spread to bone surgery designed at treating fractures and preventing fractures can provide significant relief of pain and maintenance of function for patients with this difficult diagnosis.
For most of our oncology patients, rehabilitation starts soon after surgery and once they are surgically and medically stable. Inpatient rehabilitation focuses on teaching patients how to move and function safely with reconstructed limbs and continues on an out patient basis. For patients requiring an amputation, we coordinate their post-surgery prosthetic fitting and rehabilitation as well.