The OSUCCC – James is home to central Ohio’s only dedicated Sarcoma Clinic, where our multidisciplinary experts, including surgeons, will create a comprehensive treatment program for you. For many people, surgery will play a critical role in sarcoma treatment. If you have bone sarcoma, surgery may be the ideal option to ensure the best optimal outcomes. If it’s recommended you undergo surgery, we’ll explain the procedure as well as what to expect for recovery.
Our goal will always be to remove the cancer while preserving as much of your bone as possible, but everything will depend on the type of sarcoma you have and where it’s located.
You’ll find a brief explanation of the most common bone sarcoma surgeries below, but we encourage you to ask as many questions as you need — we’re here to help you feel comfortable and confident in your ultimate treatment choice.
Surgical procedures for bone sarcoma
To remove a sarcoma tumor, we must also remove the parts of the bone it’s attached to, or in some cases, the entire bone. Depending on how much bone has been removed and which bones are involved, there are several advanced techniques available to restore the areas removed.
Allograft reconstruction
Your removed bone that was affected by sarcoma is replaced with healthy bone from a person who chose to be an organ donor. The donated bone is prepared by a tissue bank, and because its living cells have been removed, there’s no need for matching by blood type or other markers. However, we do try to match the donated bone to your sex, size, height and overall build. Your body will accept this new bone as a scaffold, and over time, your body will grow and attach enough new tissue to add strength and stability.
Autograft reconstruction
In this procedure, the removed bone is replaced with another healthy bone from your own body along with the blood vessels that keep it alive. One of the most often used bones is the fibula, which is the smaller of two bones below your knee. Because the fibula is a non-weight-bearing bone, it can be moved without causing loss of movement.
To keep the bone alive in its new location, the blood vessels are reattached and this blood supply helps speed recovery.
Metallic implants
Providing a permanent solution for missing bone that provides immediate strength and support, an implant made of metal may be a good option for larger, weight-bearing bones. These implants can be made of different types of metal that are well-tolerated by the body, such as titanium and cobalt chrome.
These implants are made with a porous surface, and these tiny holes provide the perfect structure for your body to grow and attach new bone tissue to it.
Custom metallic implants
There are many metallic implants already premade in different sizes that are completely appropriate for use in different patients. However, if you might benefit from having a custom metallic implant due to the specific bone removed or other physical factors, that can be an option. Due to the rarity of primary malignant bone tumors, not all body locations have an off-the-shelf reconstruction option so custom made implants are used. Imaging helps us create a perfectly matched replacement.
Osseointegration combined with targeted muscle reinnervation
If you have to have a limb amputated because of sarcoma, this surgery can offer better function and movement with less long-term pain and irritation than a detachable prosthesis outside your body. This option is currently only available when standard socket wear in the artificial limb has not been successful.
During surgery, a metal implant is inserted into the healthy bone next to where your amputation occurred. This implant then attaches directly into a permanent prosthesis inside your body. This prosthesis is made of porous metal to which your body will grow and attach new healthy bone tissue. We’ll also take the nerves that were cut during amputation and attach them to healthy muscles to help you eventually develop more strength and natural control of the prosthesis.
Rotationplasty and tibial turn-up plasty
If your sarcoma is in the middle part of your leg near your knee, this part of the bone may need to be completely removed. To give you more mobility than would be possible with a prosthesis or artificial limb attached at the mid-thigh level, we can use the lower section of your leg — the shin bone, ankle and foot — and rotate it 180 degrees before reattaching it to the healthy thigh bone that remains.
Your ankle joint will now work like a knee joint, and your foot will function as a shin bone. This makes it possible to use an artificial lower limb without the pain and irritation that can occur with a traditional prosthesis after amputation.
What to expect following surgery
As with any major surgery, there is a risk of blood clots and infection. We’ll monitor for these and other complications during your hospital stay and recovery. Medication, ice and gentle compression will help with pain and encourage blood flow to prevent clots. Your incisions will be kept clean and covered to prevent infection.
Short-term recovery
You’ll be encouraged to move, always with assistance, as soon as possible after surgery. We’ll help you get fitted and comfortable with the right-sized cane, crutches, walker or other assistive device that you might need.
When placing a new implant or prosthesis, the healthy bone we’re attaching it to might fracture during surgery. Small fractures will heal on their own; larger breaks may need to be stabilized with wires, screws, a metal plate or additional bone grafts.
If nerves near your implant are injured, you may have numbness, weakness or pain. Medication, physical therapy and natural healing can help improve these symptoms.
Long-term recovery
Your own recovery time will depend on the bone that’s been affected and factors like your age, overall health and other conditions you might have. You should see major improvement after three months, although your full recovery might take up to a year or more.
We’ll continue to monitor your health after you leave the hospital, and you’ll have physical therapy on an outpatient basis. A brace may be prescribed to help stabilize your new limb until you’ve developed your strength and your muscles have learned how to move with the new implant or prosthesis.
You’ll also continue with regular check-ups and have scans and imaging to confirm bone growth, muscle attachment and adequate blood supply.
View our video series on sarcoma
Rehabilitation after surgery
You’ll begin rebuilding your strength even before you leave the hospital. Our specialized therapy services include amputee rehabilitation and orthopedic rehabilitation.
The goal of physical therapy is to improve function and restore stability and range of motion. You’ll continue with outpatient therapy after you go home and your therapist will also give you exercises to do on your own.
If your surgery has impacted your ability to work or perform daily tasks, you may also meet with an occupational therapist, who can address the physical, psychological and social aspects of any lasting limitations. We even have a driver rehabilitation program to help you return to safe, independent driving.
To help you adapt and improve your quality of life, a rehabilitation psychologist is also available to help with any physical, sensory, cognitive or emotional issues that you might have after surgery.
Related resources
Bone and Spine Sarcoma
Types of Sarcoma
Prevention
Diagnosis and Screening