Apollo performs total femur replacement on a child

Apollo performs total femur replacement on a child
Apollo Hospitals Chennai has recently carried out a successful total femur replacement on a 11-year-old patient who was bedridden for months as the child suffered from osteosarcoma.

The patient was not able to walk when he was brought to the hospital and was unable to do any of his daily routines without assistance. The child was diagnosed with osteosarcoma of left distal femur (lower part of the thigh bone), a rare type of cancer afflicting the bones. It usually affects the largest bones in the body. Earlier in the year, he had undergone chemotherapy.

Osteosarcoma is usually found at the end of long bones, often around the knee joint, though occasionally seen manifesting around hip and arms. Osteosarcomas are usually high grade tumours that require an aggressive treatment regimen. It is a life-threatening condition, as the tumour can spread rapidly to other organs if not treated in the early stages of disease.

In the past, amputation of the limb for bone tumours was the only option for long term survival of a child. Recent advances in modular prosthesis and surgical technique has allowed to try limb saving strategies, which will lead to the phasing out of amputation. Hence, primary malignant femoral tumours with skip or extensive bone destruction still represent a major challenge for orthopaedic surgeons. Total femur replacement (TFR) is considered an ideal strategy that can restore femoral bone strength and allow patients to resume to normal health.

The child underwent a TFR, under a team of surgeons lead by Dr R Sankar, Senior consultant Paediatric Orthopedic Spine Surgeon at Apollo. The physicians carefully removed the femur from the body and a prosthetic (bone) was replaced. Extra care needed to be taken to save as much of the tissue as possible to support the replaced bone, said the team.

Speaking about the procedure, Dr Sankar said, “In normal circumstances, distal femur (thigh bone) osteosarcoma is treated with removal of the tumour and replacement of the removed portion with a prosthesis. When we did PET CT scan, we found another tumour focus in the top part of the same bone femoral. There was no other lesion anywhere else in the body. Hence, we decided to go for limb salvage. It was a challenge at this stage to obtain the right prosthesis. As the child is going to grow, we needed to get the right prosthesis which will be lengthened later according to his growth. Also, to make sure once the full femur is replaced, to get good soft tissue reconstruction to prevent the prosthesis dislocating from the hip joint.”

“We were able to isolate and preserve nerves and blood vessels supplying the leg. We also constructed a special pouch around hip joint to prevent hip dislocation in future,” he added.

With adequate precaution, surgery was performed successfully at Apollo Children’s hospitals. The patient was discharged within a week. The specimen sent for biopsy confirmed that the entire tumour was removed and he showed a good response to chemotherapy. Wound has healed well without any issue.

“As planned, he is getting chemotherapy post surgery. He is gradually regaining his strength in the leg and is presently walking without any support. We expect him to have a good quality of life once chemotherapy is completed,” said the team.