Limb-Salvage Surgery for Bone Tumours (Endoprosthetic Reconstruction)

Limb-salvage surgery removes a bone tumour together with a surrounding cuff of healthy tissue and rebuilds the gap, most often with a modular metal implant called an endoprosthesis or megaprosthesis that replaces the missing bone and the adjacent joint. It is used for primary bone cancers such as osteosarcoma, Ewing sarcoma and chondrosarcoma, and for some destructive metastases.

It lets around 85 to 90 percent of patients with limb sarcomas avoid amputation without reducing the chance of cure. The reconstructed limb is not normal: high-impact sport is off limits, and a significant proportion of implants need revision surgery over time.

What Limb-Salvage Surgery for Bone Tumours (Endoprosthetic Reconstruction) involves

Planning relies on MRI of the entire bone, CT of the chest, a bone or PET scan, and a biopsy placed by the same team so that the biopsy track can be removed at surgery. For osteosarcoma and Ewing sarcoma, about 10 weeks of chemotherapy usually come first. At operation, the surgeon exposes the tumour without entering it, protects the main nerves and vessels, and cuts the bone a planned distance beyond the tumour edge seen on MRI. The specimen is sent to pathology to confirm clear margins. Modular stems, body segments and a hinged or ball-and-socket joint are assembled to match the resected length and fixed into the remaining bone, with or without cement. Muscles are reattached to the implant, sometimes using a synthetic mesh sleeve, and a muscle flap may be rotated to cover the prosthesis.

Who is a good candidate for Limb-Salvage Surgery for Bone Tumours (Endoprosthetic Reconstruction)?

Suitability is decided by a sarcoma tumour board; the operation should be done only in centres treating these rare cancers regularly.

• Primary malignant bone tumours of the femur, tibia, humerus or pelvis that can be removed with clear margins
• Tumours that have responded to pre-operative chemotherapy
• Aggressive benign tumours, such as giant cell tumour, that have destroyed a joint
• Solitary or limited bone metastases, for example from kidney cancer, with a fracture or impending fracture and a reasonable outlook

Es ist normalerweise nicht die richtige Wahl, wenn:

• Tumours encasing the main nerves and vessels such that a functional limb cannot be preserved, where amputation or rotationplasty may serve better
• Tumours progressing through chemotherapy with no achievable clear margin
• Active infection in the limb
• Very young children with much growth remaining may be better served by rotationplasty or biological reconstruction than by repeated implant lengthening
• Widespread metastatic disease with a short outlook, where simpler fixation and radiotherapy are kinder

Technikoptionen

• Modular endoprosthesis: Off-the-shelf components assembled in theatre. Allows early weight-bearing; the usual choice in adults.
• Expandable (growing) prosthesis: For children; lengthened periodically, in newer designs non-invasively with an external magnet.
• Biological reconstruction: Donor bone allograft, vascularised fibula transfer or the patient's own sterilised bone. Slower recovery but potentially longer-lasting in the young.
• Custom 3D-printed implants: Used for pelvic and unusual resections.
• Rotationplasty or amputation: Durable options when limb salvage would leave a poor or unsafe result.

Was passiert während Ihrer Behandlung

Surgery lasts 3 to 8 hours under general anaesthesia, often with a nerve block or epidural. Blood transfusion is common. You wake with drains, and sometimes a brace. The first night may be spent in intensive care. Physiotherapy starts within a day or two, with walking on a frame for leg reconstructions as soon as the soft tissues allow.

Vorbereitung auf Ihre Reise

Plan for 3 to 5 weeks for surgery alone; months if chemotherapy is given there in Istanbul. Your surgeon reviews photographs and your medical history before you book, and you meet in person the day before surgery for examination, marking and consent with a professional interpreter.

• Stoppen Sie das Rauchen und Nikotin mindestens vier Wochen vor und nach der Operation; es ist die größte vermeidbare Ursache von Wundproblemen
• Erzählen Sie dem Team von allen Medikamenten und Ergänzungen, die Sie einnehmen; Blutverdünner, einige Kräuterprodukte und Hormonbehandlungen müssen möglicherweise auf Anraten Ihres Arztes unterbrochen werden
• Vereinbaren Sie, dass jemand mit Ihnen reist oder erreichbar ist, und halten Sie die ersten Tage zu Hause frei von Arbeit und Heben
• Buchen Sie einen veränderlichen Rückflug; Ihr Chirurg bestätigt, wenn Sie fit sind

Genesung und Ergebnisse

Hospital stay is usually 7 to 14 days. Chemotherapy typically resumes 2 to 3 weeks after surgery once the wound has healed. Crutches are needed for 6 to 12 weeks, and rehabilitation continues for 6 to 12 months; after knee-region resections, regaining active knee extension takes patience. Follow-up includes limb X-rays and chest imaging every 3 months for the first 2 years, then less often for at least 10 years.

• Zurück zur alltäglichen Aktivität: 3 bis 6 Monate
• When results show: Walking with aids within days; function improves over 6 to 12 months
• How long they last: Implant revision is likely within 10 to 20 years

Sicherheit, Risiken und Revisionspolitik

These are large operations in patients often weakened by chemotherapy, and complication rates are higher than after ordinary joint replacement.

• Deep infection of the implant in about 8 to 15 percent, sometimes requiring staged revision or amputation
• Local recurrence of the tumour in roughly 5 to 10 percent
• Aseptic loosening, wear or breakage of the prosthesis, with revision needed in a third or more within 10 to 15 years
• Wound healing problems, especially on chemotherapy
• Nerve or vessel injury causing weakness, foot drop or, rarely, loss of the limb
• Dislocation after hip or shoulder region reconstruction
• Leg length difference in growing children
• Blutgerinnsel in den Beinen oder Lungen

Jeder schriftliche Vorschlag wird durch Clinic-Y gibt an, was die Klinik abdeckt, wenn eine Korrektur erforderlich ist. Fragen Sie danach, bevor Sie buchen, nicht danach.

Cost of Limb-Salvage Surgery for Bone Tumours (Endoprosthetic Reconstruction) in Türkiye

Clinic-Y does not publish a single price for Limb-Salvage Surgery for Bone Tumours (Endoprosthetic Reconstruction), because the honest figure depends on your case. What moves it:

• The implant system: modular, expandable or custom-made
• Site and size of the resection, and length of surgery
• Intensivpflege und Station Nächte
• Plastic surgical flap cover if needed
• Pathology, imaging and the rehabilitation period included

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