I noticed something was “not right” with my right leg when I couldn’t sit crisscross-applesauce-style on the floor during my daughter’s music class. The tendon near my groin area was very tight and sore. Pilates exercises were difficult to complete and my left leg responded better than my right during daily activities. At the time, I thought maybe the pain was a sign of aging and simply that I needed more exercise and stretching. I continued to go about my daily life, living with pain that was sporadic and more of an ache at that point.
In March 2009, I was on a spring break skiing trip with my family when I noticed my leg felt “wobbly” during the downhill runs. I couldn’t control my right leg well and immediately knew something was wrong, so I stopped skiing. The next day, we went horseback riding and as I swung my leg up and around to get on the horse, there was a sharp stabbing pain at the top of my thigh. That was my big “ah-ha” moment. I knew that once I returned home I needed to seek medical attention, especially since the bursts of pain continued on and off throughout the rest of my trip. When I got home, I visited my primary care doctor who ordered X-rays, MRI and bone scan. After reviewing my results, my primary care doctor referred me to Dr. David Monson, an orthopaedic oncology surgeon at the Emory Orthopaedics & Spine Center in Atlanta, GA. Dr. Monson met with me and explained I had Chondrosarcoma of the hip, which is a rare type of cancerous bone tumor.
Getting the news that it was cancer was startling and left me feeling quite shocked, especially after thinking the pain was just something having to do with the typical aging process. I was expecting them to find arthritis, not cancer. What made me most nervous was the type of cancer I had and its location in my hip. During the first visit with Dr. Monson that day, he walked me and my family through the different treatment options and then recommended I take some time to compare options. Like most people would, I went straight to the internet and began researching my cancer and different options. What I found scared me – up until five years ago, most tumors of the pelvis were surgically treated through amputation. This made me extremely anxious. I didn’t want to lose my leg.
During this tough decision-making process, Dr. Monson made me feel comfortable and at peace. He was extremely knowledgeable, very caring and direct. After reviewing my options with Dr. Monson, I felt sure he was the guy to do my surgery, so I made my decision and moved forward. Andre Roy, Dr. Monson’s Nurse Practitioner, was available any time I called and provided answers to my multitude of questions. I felt very cared for and looked after at Emory, and I was impressed with the office staff every time I came in for an appointment.
In the end, we decided that during the surgery to remove my tumor, we would reconstruct my hip using a saddle prosthesis. I was pleased that Dr. Monson knew how to perform this procedure comforted that is one of the few doctors that knows how to place such a prosthetic.
Following my surgery in November of 2009, I went through extensive physical therapy. Today I am walking really well and keeping up with my active teenage daughter. My range of motion is limited so minor adjustments have been made in my daily life to stay safe and comfortable. I’m thankful to be able to do all the things that I can do now, and continue enjoying life!
Bone tumors of the pelvis are uncommon and their surgical management depends on multiple factors, including tumor size, location and whether the tumor is benign (noncancerous) or malignant (cancerous). These factors determine whether a limb-saving surgery is possible or not and if the losses associated with surgery may result in a non-functioning extremity.
Three main factors to consider with pelvis surgery relate to stability of the hip after surgery, and function of the sciatic and femoral nerves. A minimum of two out of three must remain intact for the lower limb to be worth saving. Fortunately for Mrs. Powers, both her sciatic and femoral nerves were able to be preserved and we were able to restore stability of her right hip with a saddle prosthesis.
Options for reconstruction of the hip joint after removal of pelvic bone tumors may include prosthesis such as a saddle, a cadaveric bone transplant (allograft) or sometimes no reconstruction at all. Each has its own set of advantages and disadvantages which makes selecting the right treatment for each individual patient unique based upon the factors above.
At Emory Orthopaedics & Spine Center, our goal is to always offer patients with what we expect to be the most functional, yet durable surgical reconstruction possible without compromising the long term likelihood of cure. These surgeries are often quite complex and can take as long as 6-8 hours or longer. Complications can occur and the recovery time after surgery takes anywhere from six months to a year. We want patients to be fully educated before heading into a surgery this complex.
Mrs. Powers has worked extremely hard with her physiotherapy and has achieved an excellent functional outcome. We are incredibly proud of her and most grateful that there has been no recurrence of her tumor!