Megaprosthesis Limb Salvage Surgery: A Triumph of Expertise & Collaboration

Bangalore: A middle-aged lady, a homemaker, with a history of clubfoot presented with right thigh swelling persisting for 6 months. After a confirmed biopsy diagnosis of chondrosarcoma, she was offered amputation at a Regional Cancer Center in Bangalore. Considering her lack of socioeconomic support and the potential impact on her quality of life, the patient sought a second opinion and alternative treatment options.

Due to the involvement of half of the femur length by cancer, the surgical team faced the challenge of planning a proximal femur reconstruction to ensure a cancer cure, maintain limb length, and preserve functionality. It was challenging to consider limb salvage surgery in a club foot woman.

This demanded close collaboration between the surgical oncologist and orthopedic surgeon.

A twist of fate brought together Dr. Karthik K Prasad, consultant surgical oncologist at BGS Gleneagles global hospital, Bangalore and Dr Lokesh H, Consultant Orthopedic Surgeon at Health India Hospital, Bangalore; both of whom had been batchmates during MBBS at Sri Siddharatha Medical College Tumkur, the batch of 2001. Two decades later the two friends put their minds together to preserve the limb and functionality of the limb and relieve her of cancer.

Following extensive discussions, reviewing the radiology reports and planning prosthesis, the patient was prepared for the surgery after explaining the remote possibility of amputation. The patient consented to the surgery.

The complex surgery, titled "Excision of the right proximal femur along with tumor and soft tissue component and reconstruction with mega prosthesis," was conducted on June 21, 2023, and lasted approximately 4 hours. Both surgeons navigated the challenges posed by the bulky disease, carefully preserving major vessels and nerves of the limb. Remarkably, there was minimal blood loss and no major complications.

The patient made an excellent recovery following the surgery. Her progress was consistently positive, allowing her to walk with support by the 7th postoperative day, leading to her successful discharge from the hospital.

The successful outcome of this complex surgery exemplifies the surgeons' expertise in handling such cases. Thorough pre-operative evaluation, meticulous planning, and seamless coordination with the clinical team were instrumental in achieving this remarkable patient outcome.

The collaborative efforts of Dr. Karthik K Prasad and Dr. Lokesh H at Health India Hospital, Bengaluru, demonstrated the power of teamwork and expertise in performing limb salvage surgery. This inspiring case offers renewed hope to patients facing similar challenges and emphasizes the significance of comprehensive cancer treatment with a patient-centred approach.