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Life after bone replacement surgery

After bone or joint surgery, you will need lots of physiotherapy to get your limb moving again. Eventually you should be able to do the majority of things that you did before.

Your false bone or joint

False bones and joints (prosthesis) very rarely break. But after several years there may be signs of wear and tear. They may need to be replaced. This is especially common with knee joints. Other possible complications are the prosthesis working loose, or a bone infection developing. If you feel something is wrong with your false bone or joint, get in touch with your surgeon. If you have pain or fever, see your doctor. These could be signs of a bone infection.

If you are still growing when you get your false bone or joint you will have a growing prosthesis inserted. The growing prosthesis is lengthened regularly. Older types of growing prostheses required a minor operation to manually increase the length. Newer prostheses are lengthened using electromagnets. An internal device is turned on to start the lengthening process. This is a non invasive procedure so you will not need surgery, but means you will not be able to have MRI scans. 

Changes in how you look

It can be very hard to accept changes in the way you look. Limb sparing surgery can leave you with a large scar. You may feel worried about how family and friends see you. You may feel that you are no longer as physically attractive, or feel less confident about sex. You may need more time to come to terms with all that has happened to you. It may help to talk things over with someone close to you.

The coping with cancer section contains lots of information you may find helpful including information about who can help, counselling, changes in your sex life and more.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Living with bone cancer section.

 

 

After your operation

After bone or joint surgery, you will need a lot of physiotherapy to get you going again. This is very hard work at the time. But it will pay off as you find you can move around more and more easily.

You may have to have further operations in the future if you have limb sparing surgery. You may have complications. Or if you are young and had not finished growing when you had your false bone or joint put in, you may need to have it replaced as you get bigger. Some false bones are made to expand. If you have one of these, you will still need to go into hospital from time to time to have it extended, but will not need major surgery to replace the whole thing.

Once you have recovered from your surgery, you should be able to do almost everything you did before. But some doctors advise against contact sports, such as rugby, hockey or football. It is not because the false bone is weaker in any way, but because the false bone may become damaged. If your prosthesis becomes damaged you would need major surgery to try to put it right.

 

Wear and tear

False bones and joints very rarely break. But after several years, there may be signs of wear and tear in your false bone or joint. It isn’t possible to generalise about this, as there are so many different types and makes of prostheses. But after some time, the plastic surfaces of the joint or bone can become worn and need replacing. If you have had a metal rod inserted into your bone this can sometimes become loose and so may need replacing or strengthening.

If you have had a false knee fitted due to bone cancer, you are likely to need further surgery at some point in the future. Around 3 people out of every 100 each year (3%) need a replacement knee joint.

If you are still growing when you get your false bone or joint you will have a growing prosthesis inserted. The growing prosthesis is lengthened regularly. Older types of growing prostheses required a minor operation to manually increase the length. Newer prostheses are lengthened using electromagnets. An internal device is turned on to start the lengthening process. This is a non invasive procedure so you will not need surgery, but means you will not be able to have MRI scans.

 

Complications

Eventually, most people who have a false joint or bone will develop some sort of complication that needs surgery to put it right. The most likely complications are

  • Infection
  • The prosthesis working loose
  • Mechanical failure

If you think there is something wrong with your false bone or joint, get in touch with your surgeon. The earlier you recognise a likely problem, the easier it is likely to be to deal with. The signs you should look out for are

  • Pain
  • Swelling
  • Temperature (fever)
  • An open wound over the operation site
  • A cracking sound in the joint as you move

Pain and fever may indicate that you have an infection. Infection in bone needs urgent treatment, so if you are worried, call your doctor. If a false joint feels odd, seems to be unstable or is making a noise that it hasn't made before ask your surgeon to have a look. They won't think you are being a nuisance – it is better to be on the safe side.

 

Scarring after your operation

Limb sparing surgery can be a very big operation involving cutting into a lot of tissue, bone and muscle. It may leave you with a long scar. This can cause a few problems, such as

Not everyone who has limb sparing surgery will have all these problems. It will depend on how deep your wounds and scars are, and whether you have other treatment, such as radiotherapy.

You may worry about pain after your operation. Speak to your doctor or clinical nurse specialist if you are having. pain. Pain is rarely a problem in the long term. You may have some tightness and discomfort if you have radiotherapy to the area, as this can make healthy tissues less stretchy over time.

 

Difficulty moving your limb

You will have trouble moving the affected limb to start with. But your physiotherapists will give you lots of exercises that will gradually make things easier for you. Your physiotherapist should be able to give you some idea of how things will turn out if you keep up with your exercises. For many people, there is no reason why you shouldn't be using your affected limb normally in time.

 

Changes in how you look

How you look is an important part of your self esteem. It can be very hard to accept sudden changes in your looks that you are not happy with. It is not unusual for people who have had limb sparing surgery to feel confused and upset for some time after their operation. You may feel worried about how your friends and family see you. You may feel that you are no longer as physically attractive. Going back to work, meeting new people and going for job interviews can all be more of a struggle if you are coping with changes in your appearance.

If you are very young, you may be very worried about how your friends will see you. If you have children, you may worry how this will affect them and how they will answer their own friends' questions. It is quite normal to worry about such things. The important thing to remember is that the people closest to you will not see you any differently as a person. They will want to support you as much as they can, so let them in on how you are feeling. They can help to support you when they know how you feel.

Any changes in your appearance may make you feel less confident about sex. You may need more time to come to terms with all that has happened to you. There is more about sex after cancer in the coping with cancer section.

 

Swelling in your arm or leg (lymphoedema)

Swelling is very uncommon after limb sparing surgery, unless you have also had radiotherapy to the lymph nodes that normally drain fluid from your limb.

The lymphatic system is a system of thin tubes that runs throughout the body. These tubes are called lymph vessels. Lymph is a clear fluid that circulates around the body tissues. Along the lymph vessels are small bean shaped lymph glands or nodes. You have lymph nodes all over your body, but those most affected by this type of treatment would be those

  • Under your arms, in your armpits
  • In each groin, at the top of your legs

If you have surgery and radiotherapy to these places, it can affect the drainage of lymph through these nodes. This makes it more difficult for the tissue fluid to circulate and drain out of the limb, as it normally would. It can cause a condition called lymphoedema. This is when the limb becomes swollen and heavy. You can tell if you have swelling because your rings, bracelets, watch strap or shoes may become tighter.

If lymphoedema is treated early, it can be controlled. But the longer it is left, the harder it is to get it under control. If you have swelling in the hand or foot (of the arm or leg you've had treated), talk to your doctor. If you are developing lymphoedema, you may be referred to a nurse or physiotherapist who specialises in treating it. You can also contact the British Lymphology Society for a register of lymphoedema practitioners. 

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Updated: 30 May 2013