Prominent Hospital Performs Total Femur Replacement On A Child With Osteosarcoma

Apollo Hospitals Chennai successfully completed a Total Femur Replacement on a child from Bangladesh during the pandemic. An 11-year-old patient who was bedridden for months with a severely weakening condition has been able to walk for the first time after this complex surgery performed by doctors at Apollo Hospitals Chennai.

A Case Of Osteosarcoma Of Left Distal Femur

The patient, Rajonya Chinmoy Paul, a resident of town called Tangai near Dhaka, Bangladesh, could not walk when he was brought to the Apollo Hospitals Chennai. He was unable to do any of his daily routines without someone's assistance.

The patient was diagnosed with osteosarcoma of the 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, the child had undergone chemotherapy in Bangladesh.

What Is Osteosarcoma?

Osteosarcoma (OS), also called osteogenic sarcoma, is the most common type of bone cancer that affects 3.4 per million people worldwide every year. It is the third most common cancer in adolescents. Children under the age of 15 are also diagnosed with osteosarcoma, and it is rare among children below five years of age. However, osteosarcoma can develop at any age [1].

Osteosarcoma develops in the cells that form bones. It most often affects the long bones like the ones found in the arms and legs. Osteosarcoma mainly occurs near the ends of the long bones, such as the femur (thigh bone) near the knee, proximal tibia (shin bone) near the knee and proximal humerus (upper arm bone) near the shoulder.

However, osteosarcoma can also occur in other parts of the body, such as in the pelvis (hips), jaw and shoulder bones which is common in older adults [2][3]. The cause of osteosarcoma is still not clear; however, a few factors such as genetics, rapid bone growth and radiation exposure are identified as the possible reasons [4].

Diagnosis of osteosarcoma is carried out where the doctor will perform a thorough physical examination and ask about the symptoms and medical history. After which, the doctor will conduct certain tests to diagnose osteosarcoma. These diagnostic tests include X-ray, MRI, CT scan, PET scan, bone scan and biopsy [5].

Treatment Of Osteosarcoma

In the past, amputation of the limb for bone tumours was the only option for a child's long-term survival. Recent advances in modular prosthesis and surgical technique have allowed us to try limb saving strategies, which will lead to the phasing out of amputation. Hence, primary malignant femoral tumours with a skip or extensive bone destruction still represent a major challenge for orthopaedic surgeons [6].

Treatment Of Osteosarcoma Through Total Femur Replacement By Apollo Doctors

Total femur replacement (TFR) is considered an ideal strategy that can restore femoral bone strength and allow patients to resume normal health [7]. The young patient underwent TFR, a complicated operation that requires a highly trained specialist.

In a surgery that lasted several hours, Dr R.Sankar, Senior consultant Pediatric Orthopedic Spine Surgeon, 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.

The head doctor 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 a PET CT scan, we found another tumour focus on 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."

He continued, "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 from dislocating from the hip joint. With adequate precaution, surgery was performed successfully at Apollo Children's Hospitals."

The doctors were able to isolate and preserve nerves and blood vessels supplying the leg and constructed a special pouch around the hip joint to prevent hip dislocation in future. Once the chemotherapy is carried out, the child can live a normal life.

On A Final Note...

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. The wound has healed well without any issue. As planned, he is getting chemotherapy post-surgery and is gradually regaining strength in the leg and is presently walking without any support.