Lifewatch: Bone Cancer

LAS VEGAS -- Nearly 2,400 people will face bone cancer this year, but a new surgery is saving people from the traditional amputation treatment.

Not much can slow down Isaac Escobedo, a child who was diagnosed with a tumor in his knee.

In years past, his leg would have been amputated near his thigh.  But now, a new procedure called Rotationplasty will save more of Isaac's leg.

"The whole principle being to remove the tumor from his leg, leave no tumor cells behind and then rebuild his leg as best possible to give him the best long term function," said Dr. Marc Barry.

Pediatric surgeon Mark Barry amputated Isaac's leg just above the knee, removing the tumor, but keeping the nerves and arteries intact.

He rotated the ankle 180º and reattached it.

"This is how he puts his foot down straight to let him walk around with the leg straight and this is how he bends his knee. So essentially, the ankle joint now becomes the new knee joint and the foot acts as a lever to power his artificial leg," said Dr. Barry.

The new procedure will give Isaac more flexibility and more use of his leg.

"He can run, ultimately. He can play, jump, just like normal kids," said Dr. Barry.

So far, there has been no sign of any more tumors.  Isaac is cancer free and is making a speedy recovery.


Ashlee Seymour

Director of Media Relations

Sunrise Children's Hospital

(702) 731-8288

BACKGROUND: Bone cancer. It's a frightening diagnosis that nearly 2,400 Americans will receive this year. Most of these patients will be children. Evenscarier is that more than half of that number will die from the disease this year. Primary bone cancer forms in the cells of the bone. Secondary bone cancer is cancer cells that spread to the bone from cancer in another part of the body, like the prostate, breast or lung. Some types of primary bone cancer are osteosarcoma (which begins most often in the knee and upper arm), Ewing's sarcoma (which usually begins in the backbone, pelvis, legs and arms) and chondrosarcoma (which begins in the cartilage separating bone joints).

Most causes of cancer are unknown, but there are some risk factors that seem to contribute to the development of bone cancers. According to the National Cancer Institute, osteosarcoma occurs more frequently in people who have had high-dose external radiation therapy or treatment with certain anticancer drugs; children seem to be particularly susceptible. Additionally, people who have hereditary defects of bones and people with metalimplants, which doctors sometimes use to repair fractures, are more likely to develop osteosarcoma.

TREATMENT: The most common treatment option for osteosarcoma is surgically removing the affected area. Special techniques may be used to minimize the amount of healthy tissue removed, but in many cases the entire limb must be spared. Physical rehabilitation after total limb amputation can be difficult -- both physically and emotionally. "When we were faced with this 10 or 20 years ago ... the artificial leg would have to fit onto a short stump of the leg and basically their function would have been very limited," Marc Barry, M.D., a pediatric orthopaedic surgeon in Las Vegas, Nev., told Ivanhoe. "They would have a difficult time with prolonged walking, endurance, they couldn't run or play with other kids."

Now, a revolutionary approach known as rotationplasty is giving doctors and patients more options beyond total limb amputation. During a rotationplasty procedure, surgeons remove a portion of a patient's limb below the affected portion. Then, the area containing the tumor is completely removed. The surgeon then rotates the healthy portion of the limb that was removed and reattaches it. Doctors are able to spare major arteries and nerves, maintaining feeling in the remaining limb. Then, the joint that was rotated and replaced can function as a new joint, powering the artificial limb. Dr. Barry describes the benefit for a patient undergoing a leg amputation:

"Instead of a thigh-high amputation, which is functionally not as optimal, we effectively get a below knee amputation, which gives them an extra joint to power an artificial leg," Dr. Barry said. "The other benefit is we do save the sciatic nerve, so these kids don't have phantom pains. Kids are able to walk better, have greater endurance. They are, in fact, able to run, jump, play and essentially lead very normal lives."

Reported by Kristy Ondo