Prof Len Marais
Specialist Orthopaedic Surgeon
Orthopaedic Infections, Orthopaedic Oncology, Hand, Limb Reconstruction
Orthopaedic Oncology
Orthopaedic oncology involves the management of tumours and dysplastic disorders of the limbs and limb girdles (i.e., shoulder and pelvic regions). This includes benign and malignant tumours involving bones, joints, muscles, connective tissue and fat. While some of these tumours can involve the skin secondarily, primary skin tumours are generally managed by other disciplines like plastic surgery.
Benign bone tumours
Benign bone tumours are non-cancerous growths that develop in the bones and usually grow slowly. They often cause no symptoms and are found incidentally during imaging for other concerns. When symptoms occur, they may include pain, swelling, or a noticeable lump. Although benign, these tumours can sometimes grow large enough to weaken the bone, leading to fractures or discomfort. The most common types include osteochondromas, enchondromas, and giant cell tumours. Treatment is not always necessary unless the tumour causes pain, risk of fracture, or other problems, in which case surgery may be recommended.
Malignant bone tumours
Malignant bone tumours are cancerous growths that start in the bone and can damage healthy bone tissue. They often cause pain, swelling, and may weaken the bone, sometimes leading to fractures. Treatment usually involves a combination of surgery to remove the tumour, chemotherapy to target cancer cells, and sometimes radiation therapy. The goal of treatment is to remove the cancer, prevent it from spreading, and help maintain the strength and function of the affected bone. Although facing a malignant bone tumour can be scary, we have an experienced team of healthcare professionals who work with patients to create a treatment plan tailored to their needs and provide support throughout the process.
Metastatic bone disease
Metastatic bone disease occurs when a primary cancer, like breast or prostate cancers spreads from the primary site to bone. The management of metastatic bone disease focuses on relieving pain, stabilizing the bone, and improving mobility and quality of life, with orthopaedic surgery playing a crucial role. The orthopaedic oncologist typically performs surgical stabilization using nails or plates and screws to reinforce bones weakened by cancer spread. If the joint is severely affected, joint replacement with prosthetic implants may be necessary. Additionally, bone cement can be used to strengthen the bone structure. Surgery also may involve removing tumour-affected bone segments followed by reconstruction to provide structural support. The primary goals of surgery are to prevent pathological fractures, reduce pain, restore skeletal strength, and help patients return to daily activities. Surgical decisions are individualized, based on factors such as pain, tumour size, and fracture risk, made collaboratively among the patient, surgeon, and oncologist. Surgery often leads to shorter recovery, better function, and improved survival compared to non-surgical management of fractures due to metastatic bone disease.
Myeloma and lymphoma
The management of myeloma and lymphoma of the bone involves a combination of medical and orthopaedic approaches aimed at controlling disease progression, alleviating pain, and preventing fractures. In multiple myeloma, cancerous plasma cells damage the bone, leading to weakness, pain, and risk of fractures. Treatment includes medications like chemotherapy, targeted therapy, and bone-strengthening drugs (bisphosphonates or denosumab) to reduce bone destruction. Radiation therapy may be used to shrink localized tumours and reduce pain. Orthopaedic surgery becomes necessary when there is a high risk or occurrence of fractures, spinal instability, or nerve compression. Surgeons stabilize the affected bones using metal rods, plates, or prosthetic joint replacements to restore strength and function. Surgical intervention is tailored to individual patient needs with the goal of improving quality of life and mobility. This multidisciplinary management also applies to lymphoma involving bone, with surgery playing a vital role in selected cases where mechanical stability is compromised or there are complications from tumours in the bone.
Soft tissue tumours
Soft tissue tumours are growths that develop in the soft tissues of the body such as muscles, fat, nerves, and blood vessels. When these tumours are malignant, they are called soft tissue sarcomas, which are rare cancers that require careful treatment. Surgical management is the main treatment approach and aims to remove the entire tumour along with some normal tissue around it to reduce the risk of recurrence. The type of surgery depends on the tumour’s size, location, and grade. Limb-sparing surgery is preferred whenever possible, where the tumour is removed without amputating a limb, sometimes followed by reconstruction using grafts or implants to preserve function and appearance. In certain cases, amputation might be necessary to control the disease effectively. Surgery is often combined with radiation or chemotherapy before or after the operation to shrink the tumour or kill any remaining cancer cells. The surgical goal is not only to remove cancer but also to maintain as much normal function as possible, which requires specialized surgical expertise and often a multidisciplinary team approach.
Dysplastic and metabolic disorders of bone
Dysplastic and metabolic bone disorders like fibrous dysplasia and hyperparathyroidism both affect bone quality and strength in different but sometimes overlapping ways. Fibrous dysplasia causes abnormal fibrous tissue to replace normal bone, leading to bone weakening, deformity, and fracture risk. Hyperparathyroidism, a metabolic disorder characterized by excess parathyroid hormone (PTH), leads to increased bone resorption and remodelling, causing decreased bone density, fragility fractures, and conditions such as osteitis fibrosa cystica. Surgical management in these conditions aims to stabilize weakened bones, correct deformities, and repair fractures, often using internal fixation with rods or plates and sometimes bone grafting. Addressing hyperparathyroidism through parathyroid surgery can help restore bone strength and reduce fracture risk, while medications may assist in managing symptoms. A multidisciplinary approach involving orthopaedic surgeons, endocrinologists, and pain specialists is essential to optimize function and quality of life for patients with these complex bone disorders.
