Limb Salvage Surgery for Osteosarcoma: A Fight Against Bone Cancer

lim salvage bone cancerA 16 year old boy with Osteosarcoma of Tibia Neoadjuvant chemotherapy Surgery: Wide Resection and Megaprosthesis Joint Replacement Surgery Adjuvant chemotherapy

Introduction

Osteosarcoma is the malignant bone tumor that arises from primitive mesenchymal bone-forming cells, and its histologic hallmark is the production of malignant osteoid. Each year in the United States, about 400 children and teens younger than age 20 are diagnosed with osteosarcoma. Osteosarcoma is the third most common cancer in children, after lymphomas and brain tumors. It often starts in the ends of the bones where new bone tissue forms as a young person grows. Bones in the thigh, upper arm, and leg are the most common sites. The cause of osteosarcoma is unknown and only rarely does osteosarcoma run in families. Children with retinoblastoma have a high risk for osteosarcoma in adolescence.

Xray and MRI

Skin incision and neurovascular bundle

 

 

 

 

Osteosarcoma Tibia

Megaprosthesis

 

 

 

 

knee function after megaprosthesis

Clinical Presentation

Pain and swelling in the affected bone is the most common symptom. Pain is severe in nature and associated with limitation of movement of affected joint. Initially there is small swelling and increases rapidly to bigger size. On clinical examination of swelling, local warmth with dilation of veins in the over lying area can be observed. Occasionally patients present with pathological fracture due to trivial trauma.

Investigations

Plain radiograph of the affected bone with adjacent joint is obtained with chest radiograph. The radiological findings of osteosarcoma shows a lytic/sclerotic /mixed lesion with wide zone of transition, sun ray type of periosteal reaction and soft tissue swelling. Magnetic resonance imaging (M.R.I.) is performed to visualize the extent of tumor and relationship with neurovascular structures, followed by J needle biopsy to obtain histopathological diagnosis. Staging investigations consist of Computed Tomography of chest and Bone scan or PET-CT scan.

knee joint replacement surgery

Recent Advances

Limb salvage surgery for bone tumors in the immature skeleton creates unique problems. When the estimated leg-length discrepancy at skeletal maturity is more than 3 cm or when the arm-length discrepancy is more than 5 cm expandable, Megaprosthesis is performed. The minimally invasive and noninvasive types of expandable prosthesis are used. Every six monthly the limb is expanded as compared with opposite limb until skeletal maturity is achieved.

If you are going for knee replacement surgery, make sure that you only approach a reputed institution like Shalby Hospital, Ahmedabad – one of the best centres for knee replacement surgery in India.

Author

Dr. Abhijeet Ashok Salunke
Consultant – Orthopedic Oncosurgeon
Shalby Hospitals, Ahmedabad
For More Details +91 98240 99953

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5 Most Common Knee Injuries

knee injuries
Image: orthoinfo

The knee is the most complex structure and one of the most stressed joints in the body. Knee injuries occur during the sports activities, exercising, or as a result of a fall. The symptoms people may experience are difficulty with weight bearing, pain and swelling and instability are the most common with a knee injury.

1. Fractures

The most common and often caused by high-energy trauma, such as falls from the significant heights, accidents, and during the sports activities. The most common bone broken around the knee is the patella.

2. Dislocation

It happens when the bones of the knee are forced out of normal position, either fully or partially. Dislocations can be caused by an abnormality in the structure of a person’s knee. This usually occurs from a fall, a car accident or participation in sports. sports-related contact. Examples of affected areas include shoulders, elbows, fingers, ankles, knees, hips and jaw.

3. Sprains and Strains

A sprain is a stretching or tearing of ligaments and sprain is a stretching or tearing of muscle or tendon. Sprains and strains are injuries to the ligaments. The ACL and MCL are the ligaments most often injured. These kinds of injuries usually happen during sports such as football, soccer, and the basketball. The symptoms include tenderness along the joint line and pain with walking.

4. Meniscus Tear

A most common injury happens during sports where the forceful twisting causes certain tissue in the knee to tear. The symptoms include a pain, swelling, locking, stiffness, and difficulty extending the knee.

5. Tendon Tears

The quadriceps and patellar tendons can be stretched and torn. The middle-aged people who play running or jumping sports have faced this kind of injury more often, although anyone can injure these tendons. The common causes of knee tendon injuries include a falls, direct force to the front of the knee, and landing awkwardly from a jump.

Importance of Balanced Diet for Sportsperson

sportspersons

For going an extra-mile, sportsperson needs extra performance, which comes from well balanced diet and exercise. You are what you eat. The food provides all the essential vitamins, minerals, proteins and other nutrients. Good nutrition enhances a sporting performance. Hence, a careful consideration is must when selecting what to eat.

A combination of different food items gives a balanced diet. This would include:

1. Protein rich foods – A protein rich diet helps you in many ways such as, increases your metabolism, stabilises your blood sugar levels, aids in healing of bones and slow ageing. Eggs are considered as the healthiest and great source of protein.

2. Carbohydrates – Carbohydrates break down into sugar (glucose), body’s primary energy source. This happens during digestion and later this glucose is converted into glycogen which can later be used as an energy source.

3. Vegetables and Fruits – Consuming the right balance of food and drink is important for everyone, be it a common man with sedentary lifestyle or anyone involved in sports and works strenuously. Eating a wide variety of fruits and vegetables helps maintain health and improves performance. Dark green vegetables should be eaten regularly.

Thus, a well-planned wholesome diet would meet a sportsperson’s daily requirements and provide sufficient protein and nutrients to promote and repair physical fitness. They also need to stay hydrated throughout and consume the necessary amount of water.

Source: http://bit.ly/2g8ylht