Curing Cancer with Joint-Replacement Surgery

Dr. Dave Wilson

While joint-replacement surgery is a relatively common procedure, the level of complexity increases tenfold when a patient has bone cancer.

Joint-replacement surgery involves removing the weight-bearing portion of the joint and replacing it with a metal and plastic implant. This type of procedure is typically associated with conditions like arthritis.

“In terms of oncology cases, we remove the portion of the bone and surrounding tissue that have been invaded by cancer,” explains Dr. Dave Wilson, a Musculoskeletal Oncologist at Hamilton Health Sciences. “When you remove the bone, the joint and surrounding tissue are often removed with it. Special implants and reconstructive techniques are used to provide functional joints for patients.”

Hip and knee replacements for arthritis typically take about an hour. Cancer cases are much longer, and Dr. Wilson recently performed a procedure that took 14 hours to complete.

Different types of cancers

Juravinski Hospital and Cancer Centre performs joint-replacement surgeries for two types of conditions:

• Primary tumours of bone, such as sarcoma.

• Metastatic bone disease caused by cancers that have spread to the bone. The most common causes are breast, lung, prostate and kidney cancer.

“I’ve cared for patients as young as four and as old as 104,” says Dr. Wilson. “Performing joint replacements for patients under 16 is uncommon as their bones are still growing, but it is required occasionally if the joint cannot be spared when removing the cancer.”

Positive outcomes

For metastatic bone disease, the goal is to provide a pain-free joint, prevent fractures and allow for maximum function. Whereas for primary bone tumours, the goal is to remove the cancer completely.

“Working with our colleagues in medical and radiation oncology, we can often cure patients with sarcoma of bone,” says Dr. Wilson.

“We have an amazing program and we’re lucky to have world-class experts providing top-notch care to our patients.”

Recovery from joint-replacement surgery for cancer can be long, particularly after the removal of large, cancerous tumors. Extensive physiotherapy is often required to regain strength and function.

“My patients inspire me. It amazes me how they are so resilient after experiencing a very invasive and difficult procedure.”

Research

The Musculoskeletal Oncology Unit at Juravinski Cancer Center is a world leader in evidence-based oncology research. The site recently completed the largest randomized controlled trial in the history of musculoskeletal-oncology surgery, enrolling more than 500 patients with bone cancer worldwide.

The team is also looking at novel ways to improve patient function after joint replacement surgery for cancer. This involves using three-dimensional gait analysis and computer modelling of the muscle and joint activity.

A provincial leader

Juravinski Cancer Centre is one of only three sarcoma sites in Ontario. Dr. Wilson is proud of his multidisciplinary team.

“We have an amazing program and we’re lucky to have world-class experts providing top-notch care to our patients.”