Limb sparing surgery for bone cancer

Limb sparing surgery is the main operation for primary bone cancer in the arms or legs.

This page is about cancer that starts in your bone (primary bone cancer).

If your cancer has spread into bone from another part of the body, it is called secondary or metastatic bone cancer.

What is limb sparing surgery?

Most primary bone cancers are in the arms or legs. Limb sparing surgery is the main operation for these cancers. This means removing the cancer without removing the affected arm or leg. It is also sometimes called limb salvage surgery. 

The surgeon removes the area of bone containing the cancer and may replace it with a:

• metal implant called a prosthesis 
• replacement bone either from another part of the body or from a bone bank

In some cases the affected bone is taken out, treated with radiotherapy and then put back into the body.

Why you have limb sparing surgery

If your cancer is in an arm, leg, shoulder or hip, your surgeon will want to do limb sparing surgery if at all possible. This means removing the cancer, but not the whole arm or leg.

This is the most common type of surgery for primary bone cancer. Around 85 out of every 100 (85%) osteosarcomas are treated in this way.

It is often possible to remove just the tumour even if the cancer is in your hip bones (the pelvis). In the past, sometimes the whole leg and hip had to be removed.

Getting ready for your surgery

You meet your surgical team before your surgery. The surgeon talks to you about the risks and benefits of surgery. They ask you to sign a consent form. This is a good time to ask all the questions you need to.

What happens

You have the surgery in an operating theatre.Your nurse puts a small tube into a vein in the back of your hand. Your anaesthetist gives you the anaesthetic medicine through the tube and you go to sleep. 

The surgeon removes the area of bone containing the cancer and replaces it with a metal implant called a prosthesis. If the cancer is near a joint, the surgeon will remove the joint as well and replace it with a false one.

You more commonly have this surgery to bones in the leg, such as the femur or tibia. These operations are called femoral replacement surgery and tibial replacement surgery respectively. 

It is also done in the major bone in the upper arm, called the humerus. This operation is called humeral replacement surgery.

The most important thing is that the surgeon removes all the cancer. So they also take out a margin of healthy bone tissue all around the cancer. They send this to the laboratory to be carefully checked to make sure all the cancer has been removed.

Once the cancer is all out, the surgeon then performs the limb reconstruction part of the surgery.

Sometimes during the operation the tumour is found to be larger than the scans had shown or unexpectedly involves the nerves or blood vessels. When this happens, limb salvage may not be possible and an amputation has to be done instead.

After surgery

Your multidisciplinary team (MDT) will help you after your limb sparing surgery. This includes physiotherapy and rehabilitation.

Possible risks

Infection

Infection is a risk with any bone surgery. It is a particular risk for people having chemotherapy. Your surgical team will do all they can to prevent infection. You have antibiotics during your operation to try to reduce the risk of an infection.

Once infection develops in the bone or a metal implant, it is very difficult to get rid of it. If you get a severe infection it can break down the bone around the prosthesis. The prosthesis then becomes loose and unstable.

It is sometimes possible to cure bone infections, but this usually means more surgery. Your specialist will have to take out the prosthesis, wait for the infection to completely clear and then put in a new prosthesis. Unfortunately, if it isn’t possible to get the infection under control, you may need an amputation.

Other risks

There are other risks of having limb sparing surgery. Your doctor will talk them through with you.

Your doctors will make sure the benefits of having limb sparing surgery outweigh these possible risks.

Follow up

At your first follow up appointment, your doctor:

• gives you the results of the surgery
• examines you
• asks how you are and if you've had any problems  

This is also your opportunity to ask any questions. Write down any questions you have before your appointment to help you remember what to ask. Taking someone with you can also help you to remember what the doctor says.

How often you have follow up appointments depends on the results of your surgery. Ask your doctor how often you need to have these and what they will involve.