25 year male, came to the outpatient clinic of orthopaedic oncology 3 months back, after taking opinion from some renowned hospitals in Mumbai. He was confused, dejected and in hope to save his leg.
At another tertiary cancer referral hospital he was informed that he suffers from a tumour in pelvic bone for which the treatment is neo adjuvant chemotherapy followed by surgery and later adjuvant chemotherapy. He was also informed that this surgery involves removal of the pelvic bone and patient would be bed ridden for nearly 6 -7 months and will eventually have one limb shorter than other limb by 5-7 cms.
The difficulty in his case was the site of his cancer, around the hip joint, one of major weight supporting joint in body surrounded by all important structures. In such cases it is a tough task for cancer surgeon to remove the tumor and save the limb as well.
Most common treatment advised is amputation with chemotherapy or removal of part of whole of pelvic bone followed by which patient will be in bed for 6 months with a severely shortened leg.
Historically, the treatment of pelvic bone tumours hasn’t changed since the inception and the surgical treatment of such bone cancers leaves too much functional deficit and these surgical procedures have a grave psychological impact with difficulty in daily activities and rehabilitating back into society and work.
One of the surgical alternatives available in such a situation where the limb could be saved, such as removing the pelvic bone with cancer and replacing it with allogenic graft( pelvic bone from organ donars), this graft should be fresh frozen and these fresh frozen graft are not available in India due to lack of donor and this technique is also associated with complications like fracture of graft, non union to parent bone and infection.
Some newer surgical alternatives are also available in these cases where the limb could be saved, such as removing the pelvic bone and replacing it with 3D reconstructed metal prosthesis of pelvis with replacement of hip joint with chemotherapy before and after the surgery. These customized patient specific pelvic prostheses could accurately fill the bone defect created.
If metal prosthesis is planned then there are multiple advantages associated with this surgical procedure among them the most important is maintaining and recreating anatomical structure of pelvis that will regain normal functional outcome, psychological harm will not be there as compared to other options.
On seeing the X-rays and MRI of this patient and after detailed discussion, Dr Himanshu and his team were able to provide this novel and innovative surgical treatment using 3D imprinting technology for this specific case.
Recently, in the studies done outside India, these techniques showed good functional outcome and higher satisfaction rate.
This innovative surgical technique needs expertise and to our knowledge no other tertiary cancer centres in India provide this form of specialized treatment to bone cancer patients.
At KDAH we were successful in safely removing the cancer with replacement of the excised pelvic bone with custom made prosthesis; we have the same young man walking on his new hip without the fear of cancer.
In Maharashtra, KDAH is the first and only hospital in private sector to provide these services for bone cancer patients.
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