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Most patients with tumors in the arms or legs can have limb-sparing surgery, but this depends on where the tumor is, how big it is, and whether it has grown into nearby structures.

Limb-sparing surgery is a very complex operation. The surgeons who do this type of operation must have special skills and experience. The challenge is to remove the entire tumor while still saving the nearby tendons, nerves, and blood vessels to keep as much of the limb’s function and appearance as possible. If the cancer has grown into these structures, they will need to be removed along with the tumor. In such cases, amputation may sometimes be the best option.

The section of bone that is removed along with the osteosarcoma is replaced with a piece of bone from another part of the body or from another person (a bone graft), or with a man-made device made of metal and other materials that replaces part or all of a bone (an internal prosthesis). In some cases, a graft and a prosthesis are used.

Potential complications

Complications can include infections and grafts or rods that become loose or broken. Patients who have limb-sparing surgery might need more surgery in the following years, and some might still eventually need an amputation.

Using an internal prosthesis in growing children is especially challenging. In the past, it required occasional operations to replace the prosthesis with a longer one as the child grew. Newer prostheses have become very sophisticated and can often be made longer without any extra surgery. They have tiny devices in them that can lengthen the prosthesis when needed to make room for a child to grow. But even these prostheses may need to be replaced with a stronger adult prosthesis once the body stops growing.

It takes about a year, on average, for people to relearn to walk after limb-salvage surgery on a leg. Physical rehabilitation after limb-salvage surgery is more intense than after amputation, and it is extremely important. If the patient does not actively take part in the rehabilitation program, the salvaged arm or leg might not work well. In many patients, some limitations may be placed on physical activity to protect the salvaged limb from injury.

For some patients, amputation may be the best option. For example, if the tumor is very large or if it extends into the nerves and/or the blood vessels, it might not be possible to save the limb. For some patients, they may choose an amputation even when limb salvage might be an option, for reasons that often include physical activity limitations.

The surgeon determines how much of the arm or leg needs to be amputated based on the results of MRI scans and an examination of tissue that was removed by the pathologist during the surgery.

Surgery is usually planned so that muscles and the skin will form a cuff around the remaining bone. This cuff will fit into the end of a prosthetic (artificial) limb. Another option might be to implant a prosthesis into the remaining bone, with the end of the prosthesis remaining outside the skin. This can then be attached to an external prosthesis.

Reconstructive surgery

Reconstructive surgery can help some patients who lose a limb to function as well as possible. For example, if the leg must be amputated mid-thigh (including the knee joint), the lower leg and foot can be rotated and attached to the thighbone, so that the ankle functions as a new knee joint. This surgery is called rotationplasty. Of course, the patient would still need a prosthetic limb to replace the lower part of the leg.

With proper physical therapy, a person is often able to walk on their own 3 to 6 months after a leg amputation.

If the osteosarcoma is in the shoulder or upper arm and amputation is needed, in some cases, the area with the tumor can be removed and the lower arm reattached so that the patient has a functional but much shorter arm.

This may be the hardest part of treatment, and it cannot be described here completely. It may be helpful to meet with a rehabilitation specialist before surgery to learn about options and what might be required after surgery.

If a limb is amputated, the person will need to learn to live with and use a prosthetic limb. This can be particularly hard for growing children if the prosthetic limb needs to be changed to keep up with their growth. While the prosthetic limb can be remade whenever it is needed, they are expensive, and each new limb needs time for the person to adjust to it.

In a limb-sparing operation, the situation can sometimes be even more complicated, especially in growing children. Regular visits for lengthening of the prosthetic or replacement surgeries may be needed to suit their growing body and physical needs.

When researchers have looked at the results of the different surgeries in terms of quality of life, there has been little difference between them. Discuss your options and the rehabilitation that will be needed after surgery with your cancer care team.

Many people worry about the social effects of their operation. Emotional health is very important, and support and encouragement are available from your cancer care team. See After Osteosarcoma Treatment for more information.

Tumors in the pelvic bones can often be hard to remove completely with surgery. But if the tumor responds well to chemotherapy first, surgery (sometimes followed by radiation therapy) may get rid of the cancer. Pelvic bones can sometimes be reconstructed after surgery, but in some cases pelvic bones and the leg they are attached to might need to be removed.

The entire lower half of the jaw may be removed and later replaced with bone grafts from other parts of the body. If the surgeon cannot remove all the tumor, radiation therapy may be used as well.

Tumors in areas like the spine or the skull may not all be removed safely. Cancers in these bones may require a combination of treatments such as chemotherapy, surgery, and radiation.

Tumors across a joint may need treatment that includes joint fusion (arthrodesis) if the joint cannot be rebuilt. This is most often used for tumors in the spine, but it might also be used in other parts of the body, such as the shoulder or hip. While it can help stabilize the joint, the person will have to learn to function with reduced mobility.