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. The 
gives you the 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 or . The name of the operation to the femur is called femoral replacement surgery. If you are having surgery to your tibia it is called tibial replacement surgery.
Surgery is also done on the major bone in the upper arm called the . 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
Immediately after surgery you go to the recovery room. You will have one to one nursing care. The nurse looks after you until you are awake and well enough to go back to the ward.
You’ll initially have an oxygen mask over your nose and mouth. Or you may have oxygen through 2 small plastic tubes that rest in each nostril (nasal prongs). You may have several other different drains and tubes in place after surgery. Your nurse will explain what they are for.
You might have:
- drips to give you medicines and fluids until you are eating and drinking again
- tubes into your neck or arms to measure your blood pressure
- a drain coming from the wound
- a tube into your bladder (catheter) to collect and measure the urine you pass
- leads connected to sticky pads to check how well your heart is working
- a fine tube into your back that goes into your spinal fluid (epidural) to help relieve pain
Your wound is closed with either dissolvable stitches or skin clips. This is then covered with a clear dressing. You might also have your limb covered with tightly fitting bandages when you wake up.
Your surgeon gives the nurses and physiotherapists detailed instructions about your recovery. Physiotherapists, nurses and other healthcare professionals will help you after your limb sparing surgery.
Possible risks
Infection
You are at risk of getting an infection after any operation. This is a particular risk for people having chemotherapy. This risk of infection includes areas such as your wound, chest or in your wee. 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.
Tell your doctor or nurse if you have any symptoms of infection.
They include:
- a high temperature
- shivering
- feeling hot and cold
- feeling generally unwell
- cough
- feeling sick
- swelling or redness around your wound and your wound might feel hot
- a strong smell or liquid oozing from your wound
- loss of appetite
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.
Blood clots
Blood clots (deep vein thrombosis, DVT) are a possible complication of having surgery. This is because you might not move about as much as usual. Clots can block the normal flow of blood through the veins. Let your doctor or nurse know if you have an area in your leg that is swollen, hot, red or sore.
There is a risk that a blood clot can become loose and travel through the bloodstream to the lungs. This can cause a blockage in the lungs. This is known as a pulmonary embolism. Symptoms include:
- shortness of breath
- chest pain
- coughing up blood
- feeling dizzy or lightheaded
If you have any symptoms of a blood clot when you are at home, you should contact a doctor immediately. This might be your emergency GP service. Or call 999 or go to your nearest accident and emergency department (A&E).
To prevent clots it's important to do the leg exercises that your nurse or physiotherapist taught you. Your nurse might also give you an injection just under the skin to help lower the risk whilst you are in hospital. You might need to carry on having these injections for 4 weeks, even after you go home. This depends on the type of operation you had.
Your nurse might teach you to do these injections yourself before you go home. Or a district nurse might come to your home to do them.
It's important to continue wearing compression stockings if you have been told to by your doctor.
Bleeding
There is a risk that you will bleed after your operation. The team looking after you will monitor you closely for signs of bleeding. The treatment you need depends on what is causing the bleeding and how much blood you lose. You might need a .
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.
