Limb-sparing surgery for bone cancer is common practice nowadays but very young children with bone cancer face significant challenges and have limited surgical options.
The current issue of New England Journal of Medicine illustrates a case of a five-year-old girl with Ewing’s sarcoma, a cancerous tumor, behind her left knee. Surgeons at The Children’s Hospital of Philadelphia used a limb-sparing technique called rotationplasty to remove the diseased portion of bone, turn the shortened portion of the leg bone in a half-circle and reattach it, with the ankle joint functioning as a knee. With a prosthetic attached to the mobile joint, the child, now 13, enjoys gymnastics and cheerleading.
“For very young children with cancer above the knee, one option is rotationplasty. This procedure removes the involved bone and replaces the knee joint with the ankle joint; to do this, surgeons rotate the leg halfway around before reattaching it. By moving up the ankle and reattaching it to where the knee joint was, we can preserve more mobility,” says John P. Dormans, M.D., chief of Orthopaedic Surgery at The Children’s Hospital of Philadelphia. “The patient is fitted with an artificial prosthesis to replace the missing lower leg while retaining full knee mobility.”
Limb-sparing procedures are a growing option for very young children with malignant tumors of the extremities because of several advances such as magnetic resonance imaging (MRI) that improve the surgeon’s ability to visualize and access tumors before surgery. Removing only the tumor while sparing the limb is also easier with improved chemotherapy regimens. The drugs shrink tumors so more tissue, bone and muscle can be spared and better mobility can be restored.