Surgery On Bone Cancer

Surgical Resection With Limb Conservation.

This is where the cancer is removed without removing the affected arm or leg.

Curettage

Curettage is the removal of the tumour (intralesional resection) and trying to save as much bone as possible.
This involves removing some normal bone using a cortical window. The tumour cells are scraped from the area to create a hole.
Surgeon fills the hole with bone cement or bone graft or cementless fixation, making it strong and to prevent tumour from returning. This is referred to as endoprosthetic reconstruction.
This limb-salvage option is also suitable for periarticular tumour resection and can minimise risk of infection and aseptic loosening (the body’s inflammatory response to wear particles from a joint replacement implant leads to bone loss and implant failure).

A visual presentation of the main types of resection and intralesional curettage

An example of where curettage is used is osteoid osteoma.

Osteoid Osteoma is a benign tumour that affects long bones. Under general or regional anaesthesia, curettage can be performed in such cases.

This can be treated with non-steroidal anti-inflammatory drugs (NSAIDs) e.g. aspirin and ibuprofen, to relieve pain.

Surgical Excision

This is a wide excision that is commonly performed in patients with low-grade tumours.
This is where the tissue is removed using a sharp knife called a scalpel or other cutting tools. It also removes some of the normal tissue to ensure all the tumour has been removed. This prevents the tumour returning, e,g giant cell tumours.
If the tumour is aggressive and causes lots of damage, the surgery becomes more invasive.

A visual presentation of a scalpel scraping into removing the Ewing Sarcoma on the bone

Tumor excision to preserve the epiphysis. a Transmetaphyseal excision (epiphyseal plate preserved), b transphyseal excision (partial removal of the epiphyseal plate), and c transepiphyseal excision (total removal of the epiphyseal plate). The dotted line indicates the osteotomy line
Akihiko Takeuchi et al. 2019

Open Reduction And Fixation

Limb rotation surgery

Reconstructive Surgery

With any surgery that has a large portion removed, reconstruction is needed. This may involve bone grafts, metal implants or advanced reconstructive processes to restore structure and function.

Limb-sparing surgery and Bone Grafts

If the tumour is in a limb, some bone needs to be removed or replaced using a metal implant (prosthesis) or a bone from another part of the body (bone graft).

Bones can regenerate by themselves.

However, large bone defects require bone grafts.

Examples of bone grafts that can be used for a tibial defect. It can be either taken from the ilium of the hip or it can be taken via the distal femur in the medullary canal using an aspirator and proximal tibia/upper tibia in the epiphyseal plate region where a bone graft can be harvested or obtained. A bone graft can then be placed where it is needed in this case, the middle of the diaphysis. It is held in position by a surgical plate that is screwed or an internal nail or an external monolateral fixator. The ultimate outcome is a healed bone.

Examples of fixation surgery: internal and external and closed reduction surgery. Internal fixation is where the bones are reduced to their normal size that can be aligned and placed together with screws, plates and/or an oblique tension band wire. External fixation is recommended in the presence of open fractures with contamination or impending compartment syndrome where it is commonly either temporary placed or added as a therapeutic option for stability of the region. There is minimal excision and the metal is removed at the end.

Types Of Grafts

Autograft or autologous or autogenous grafts.

What is an autologous graft?

This type of graft is where there is a removal of a bone area from the patient himself or herself.

This is commonly performed during osteoinduction, osteoconduction, and total histocompatibility of autografts.

This helps to lower immune reaction and transmission of disease. There is a risk of donor-site morbidity.

There could also be a limited amount of tissue to harvest or obtain, further additional surgeries, and prolonged surgery times.

This is overcome by allograft and xenograft which will be discussed later.

What Is Osteoconduction, osteoinduction, and osteogenesis?

Osteoconduction – Some materials appear like a scaffold where bone cells attach, move, grow, and divide.

Osteoinduction – normal chemicals in the body cause stem cells or immature bone cells to grow and mature to form healthy bone tissue.

Neovascularization – the formation of new blood vessels as part of microvascular networks. It is different from angiogenesis (formation and sprouting of new blood vessels, e.g., capillary buds from pre-existing blood vessels).

An insight into Dental Bone Graft

A bone graft or implant is when a rigid structure is embedded in bone or is under its periosteum (outer covering of the bone) to provide support for its replacement teeth on a denture or a bridge.

There are also osseous-integrated implants, which are a type of implant where special titanium metal alloy inserts called fixtures are placed in the jawbone (mandible and maxillae). There are structures called abutments which are fitted after the bone has healed. An artificial tooth is then placed or bolted onto the abutments.

They also help to retain facial prostheses.

Key areas of bone grafts:

Oral: anterior maxillary sinus wall, anterior nasal spine, ascending ramus, palate (hard/soft), symphysis, tuberosity
Anterior maxillary sinus – air-filled spaces lined with mucous membrane and some bones of the skull.
Anterior nasal spine – part of the nose that form the bridge and root of the nose.
Ascending ramus – a process projecting from the bone e..g rami of the mandible
Palate – roof of the mouth that separates the mouth from the nasal cavity. The hard palate is at the front of the mouth and is formed from the maxillae and palatine bones. The soft palate is further back in the mouth and links with a flap of tissue called uvula.
Symphysis – the line that marks the fusion of the two bones during development e.g. mandible
Tuberosity – large round protuberance on a bone that serves attachment to muscles and ligaments
Body: Cranium (skull). Upper limbs (radius), Lower limbs (tibia, fibular) and pelvis (iliac crest)

Supporting Images Of Dental Implants

The structure of the maxillae (lateral and medial view)

Axial view presenting the maxillary sinuses , ducts, processes and bones

A recap on the structure of the skeleton

Iliac Crest

Allograft

Bone obtained from living or non-living human donors through a bone tissue bank.
These grafts typically contain minerals such as hydroxyapatite and calcium phosphate.
Dense cortical bone is used to fill gaps, promote bone formation, and aid healing.
Allografts are osteoconductive, provide little osteoinductive potential, and are not osteogenic.

A gentle reminder:

Osteoconduction – Some materials appear like a scaffold where bone cells attach, move, grow, and divide.

Osteoinduction – normal chemicals in the body cause stem cells or immature bone cells to grow and mature to form healthy bone tissue.

There is a risk of transmitting diseases with these grafts. Variability depending on the method.

Fresh/frozen bone

FDBA – freeze-dried bone allograft

Allograft that maintains natural calcium and mineral content.

It provides stability and space for bone healing.

It has a slow resorption (bone breakdown) rate, and therefore it helps to form dense bone.

Suitable for surgeries where there is durable scaffolding and predicted bone volume.

DFDBA – demineralized freeze-dried bone allograft

This is the removal of bone morphogenetic proteins (BMP) that induce osteoinduction.

This helps to speed up the rate of resorption, but its mechanical strength and volume stability are lower than its alternatives.

Xenograft

They are harvested or “obtained” from bovine, porcine, equine, coralline and algae.
They are osteoconductive, but there is risk of disease transmission, immunogenicity (immune response) and variability in properties.

Osteoconduction Some materials appear like scaffold where bone cells attach, move, grow and divide.

Bovine –> cattle.
Caprine –> goats
Equine –> horses, mules, zebras, and asses/donkeys.
An ass is a single hoofed mammal of the genus Equus, related to horses.

They are smaller in build and have bigger ears. It includes mule, burro, hinny, jack, and donkeys.

Ovine –> sheep.
Porcine –> swine/pig
Coralline algae –>

It is a type of red algae that precipitates/releases calcium carbonate in its cell wall, giving a stony, hard texture.

Supporting Images Of Xenografts

Differences in the height and the shape of the back

Synthetic bone graft

Synthetic bone graft.

Culture and Diversity: Implants of animal tissues may be rejected by some patients because of religion, culture, and ethical concerns about animal rights.

This limitation is overcome by using artificial grafts that have been added to repair bone defects.

Calcium phosphate
Hydroxyapaptite
Calcium carbonate
Calcium sulphate
Bioactive glasses
Osteoconductive

Variability of properties depending on method.

Amputation Of The Limbs

This is the removal of the affected limb and is commonly done to prevent spread to the surrounding area, especially if it affected nerves and blood vessels.
The limb can be rebuilt with surgery to maintain function, but the process varies by patient.

Metastasectomy

The removal of the cancer that spread to another part of the body.

Laminectomy

The procedure of relieving pressure on the spinal cord or nerves and symptoms such as herniated discs and spinal stenosis by removing all the vertebral bone (lamina) – bony arch

This helps to decompress by lowering pain and numbness and tingling in back, arms and legs and improve nerve function.

Herniated disc can influence inner part of the disc in the forament called the nucleus pulposus

Types of negative effects of the disc. The laminectomy helps to relieve the pain by removing the spinoid process to help relieve the nerve compression that otherwise affect the lower limbs of the legs

Bone-Anchored Hearing Aid

Small titanium screw fixed in bone of skin behind external ear using osseointegration method.

Osseointegration is defined as the process by which materials, for instance titanium metal, may be introduced into the living bone without forming a reaction.

Post-Surgery

Depending on the outcome,

The most important aspect is rehabilitation to regain mobility via physiotherapy.

Bone Cancer Surgery: What Actually Happens and Recovery By Ginger Healthcare.

What Physical Therapy Techniques Help With Bone Cancer By Bone Cancer Relief Guide

References

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Updated July 2026 Next Review July 2028