Expert orthopedic surgeon saves man’s leg from being amputated after damage from advanced cancer

Richard Monti, a father of six and a real estate developer on Long Island, thought that his metastatic kidney cancer diagnosis would be the toughest battle to endure in his life. But after surgery aimed to repair his fractured upper shinbone—damaged by cancer and cancer-killing radiation therapy—sepsis developed and sent him a new, and sudden, life-threatening challenge.

Monti was intubated and in a coma for several weeks, undergoing six surgeries to clean out infection and necrotic bone from his leg and restore skeletal stability. When he recovered, doctors delivered more difficult news to him and his wife: they'd need to amputate his leg above the knee.

"I just listened, and we left. At that point, we had no hope, and I was probably at my lowest," Monti said. "I'm the type of man that works on my feet. My body moves, my mind moves. Losing that leg, I thought that this is the way my story ends."

Monti was seeking a second opinion and was connected to Nicola Fabbri, MD, a professor in the Department of Orthopedic Surgery and chief of the Division of Musculoskeletal Orthopedic Oncology at NYU Grossman School of Medicine, who thought amputation was a major surgery with no real benefit for someone who would have to continue cancer treatment during his recovery from surgery. Dr. Fabbri, who is also at Perlmutter Cancer Center, wanted to place Monti in a leg brace so he could continue to receive cancer treatment without having to make a major decision like amputation.

Monti's case was highly unusual, and in equal parts complicated. He was dealing with an unhealed fracture of the upper part of his tibia, and soft-tissue damage from the life-threatening sepsis infection and radiation treatment for metastatic cancer to his bone, which resulted in significant bone loss and weakness of his residual tibia.

Dr. Fabbri also thought that giving the leg time to heal might give Monti the option to undergo a knee replacement at a later date. Not only did the soft tissues of the leg heal well enough for the surgery, but Monti also had a remarkable response to the cancer treatment. After 15 months of being in a brace and on crutches, Monti underwent a limb-preserving surgery consisting of a complex knee and tibia reconstruction.

As part of the surgery, Dr. Fabbri removed the metal plate and cement from the prior attempt at knee reconstructive surgery and added cemented stems to secure the knee implant to his femur and tibia. This way, he was able to correct a long-standing severe bowing deformity caused by a fracture through pathologic (diseased) bone.

A portion of the upper tibia close to the knee was damaged, so Dr. Fabbri removed that piece and used a metal implant to fill the gap. The plastic surgery team then used a surgical procedure that mobilizes the soft tissues from a portion of the calf musculature and rotates them over the knee, providing adequate coverage for wound healing.

Now, Monti is pain-free and able to walk without a cane or crutches. Monti considers Dr. Fabbri's work a miracle, and he's back to work.

"I really never thought he could come back at this level," Dr. Fabbri said. "It's really remarkable where he is today."

A huge recent milestone: Monti visited his daughter's prospective nursing school in Miami and happily walked on the beach. His daughter decided to pursue nursing after her father's health battles.

"I asked her why she was so determined to be a nurse," Monti said. "She said, 'Sitting there watching you all those months, I learned I had a lot to offer.' I'm so proud of her."

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