Motionless, painful with bone cancer
On the afternoon of February 22, doctors at the Centre for Joint Surgery and Sports Medicine, under the Hanoi-based Tam Anh General Hospital successfully performed the surgery to replace the entire thighbone for the child patient to treat her bone cancer.
Q.A, 11, from Ho Chi Minh City, had suffered a dull pain in right thigh which increased over the past year. Her family sent her to the HCMC Children's Hospital where she was diagnosed with femoral cancer and transferred to HCMC Cancer Hospital for continued treatment.
However, after three chemotherapy sessions, she did not get better, while there were signs that the tumour continued to grow, leading to an invasion, breaking the thighbone and causing the child to have the entire right leg cast. At the same time, she still had to endure motionlessness and nagging pain, while continuing to receive further treatment to prepare for next surgeries to remove the tumour.
Her family tried their best to take Q.A to Hanoi for further treatment in the hope of keeping her right leg. At the Centre for Joint Surgery and Sports Medicine, Professor, Dr. Tran Trung Dung, in charge of the centre’s expertise, said that bone cancer in children is a dangerous disease with very high malignancy properties, which not only puts patients at risk of disability but even risks their lives.
In the case of Q.A, the tumour had overgrown along the femoral body, leading to fracture. Therefore, the only solution is to remove the entire thigh bone with the tumour. But if there is no alternative to the defective position of the bone, the risk of having to amputate her leg to save her life is very high. As the child is still too young and the family yearns to put a lot of faith in the preservation of her legs, doctors at the centre have found the most suitable solution for her.
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The giant tumour that destroyed almost the entire right thighbone of the patient.
Daring decision to replace artificial bone for the young patient
With their experience of having successfully replaced artificial bones for a number of cases in Vietnam, specialists gathered to seek solutions in this case. Finally, the decision was made to remove the entire cancerous femur and then replace this removed bone with an artificial thighbone made of titanium alloy material. However, this is the youngest child patient in Vietnam to this case, so doctors must consider many factors.
Experts have to carefully measure and calculate how they can replace the artificial bone that is almost identical to the child's bone to help Q.A be able to recover and walk normally as before. Just a small mistake in the design and the child may experience complications such as dislocation or stiffness right after the surgery.
To solve the remaining difficult part of this problem, Professor, Dr. Tran Trung Dung said: "We have to scan a 3D model of the entire two legs of Q.A before the surgery to simulate the parameters of the femoral bone that needs to be replaced. At the same time, we also calculate whether the muscle tendon around the remaining bone is enough to ensure the child's leg works or not. We planned to use positioning robots throughout the operation to ensure the surgical steps are of the highest accuracy."
Undergoing a pre-operative chemical treatment and a major surgery that lasted nearly three hours, doctors finally removed the damaged thigh bone and the giant tumour measuring 28x10cm, weighing nearly three kilograms, while successfully replacing artificial femur with artificial hip and knee joints.
Dr. Dung said this artificial thigh bone is designed for 3D printing with super durable, light titanium alloy ordered in accordance with the anatomical design parameters provided by surgeons. This artificial femur is designed in the form of a removable module, so when the child grows up, the doctor can lengthen the surgical leg to match the healthy leg.
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The 3D printed titanium alloy artificial thighbone made in line with the anatomical parameters of the patient.
In addition, thanks to the positioning support of the Artis Pheno robot and surgeons’ expertise, the function, length and shape of the two legs of the patient after surgery are similar.
"If the postoperative progress is favourable, after only two days, the patient will be able to sit up and practice walking with support equipment," Dr. Dung informed.
The surgery at Tam Anh General Hospital is the 3rd complete replacement of the thighbone in Vietnam and the 2nd case of replacing the entire thighbone due to cancer. More specifically, in research in the world medicine documents, this is a femoral replacement surgery for the youngest patient in Vietnam and the 2nd youngest in the world, after a similar surgery on a ten-year-old patient in in Egypt in 2010.
Over the past year, Professor, Dr. Tran Trung Dung and experts at his centre have been very successful in many complicated surgeries, such as replacing one side artificial pelvis, replacing eight finger joints at the same time and replacing complicated shoulder, elbow, hip, and knee joints.
This team is also the same as the first two artificial thigh replacement surgeries in Vietnam. Fortunately, the first thigh bone replacement due to cancer on a 25-year-old girl was a success, and now after nearly two years since the surgery, she is still healthy and is currently working as a medical secretary for the surgical team that saved her leg at Tam Anh Hospital.
