Orthopedic Surgical Oncology

Our areas of expertise in orthopedic cancer surgery

At UCSF Health, our musculoskeletal surgical oncologists are experts in limb-salvage procedures and specialized amputations. We also treat musculoskeletal problems, such as fractures, pain and mobility issues caused by sarcomas, as well as cancer that has spread to bones (metastatic bone diseases).

Our team helps patients and families understand their treatment options and what to expect before, during and after surgery. We also offer comprehensive support services to aid your recovery, from physical rehabilitation to integrative medicine.

Limb-sparing surgery and reconstruction

Our surgeons excel in limb-sparing surgery to remove tumors from the arms and legs without amputation. They use a variety of techniques to preserve and reconstruct the damaged limb, helping retain its function and delivering the best possible cosmetic results.

Limb salvage and reconstruction techniques for bone or soft tissue tumors may involve:

• Endoprosthesis. We replace a diseased bone or joint with an internal artificial implant, such as in your thigh bone or pelvis.

• Internal fixation. This procedure uses screws, plates or implants to stabilize bones and prevent fractures caused by tumors or other diseases.

• Biologic reconstruction. We use a combination of living grafts (bone or tissue from another area of your body or from a donor) and internal fixation to achieve better limb function and long-term durability.

• Microsurgery. We reconstruct the area where a tumor was removed, using tissue and blood vessels from another area of your body.

• Bone transport. This procedure uses an implanted device to grow a new bone in an area (such as your shinbone) where the bone is missing.

Osseointegration limb replacement

If amputation is necessary, our surgeons specialize in osseointegrated percutaneous implants to improve comfort and mobility for people who need prosthetic limbs. Percutaneous means the procedure is done through the skin.

During osseointegration, we anchor an implant device to the remaining (residual) bone after amputation. We connect the prosthetic limb directly to the implant, avoiding the need for a socket.

Surgeons at UCSF Health were the first in the U.S. to perform this advanced technique for people with above-the-knee amputations. We were also at the forefront of developing the compressive osseointegration implant, which improves the durability of endoprostheses.

Benefits of osseointegration include:

• Better prosthesis stability

• Improved balance and walking

• No pressure sores, pain or skin irritation caused by an external socket

Targeted muscle reinnervation

Some people who need amputation or have already had one are candidates for an advanced procedure called targeted muscle reinnervation (TMR). During TMR, our orthopedic surgeons and neurosurgeons connect severed nerves in the residual limb to functional nerves that control muscles. This can help relieve nerve pain and may improve the use of upper limb prostheses.