Writing in a research letter in tomorrow's issue of The Lancet, Dr. Marco Manfrini from the Rizzoli Orthopaedic Institute in Bologna and his colleagues describe the procedure that was done.
The girl was 4 years old when she came to their attention in mid-1997 with a diagnosis of Ewing's sarcoma, a bone tumor. The cancer extended from the upper part of her femur, or thighbone, which makes up the "ball" part of the hip's "ball and socket" anatomy, to the middle of her thighbone. Today, the girl has full hip mobility and can attend school, ride an exercise bike, swim and walk without canes at home. She also has no discrepancies in limb lengths.
While surgeons have previously reconstructed other skeletal segments lost to cancer, the Italian authors note that "no limb-salvage techniques have been described for hip reconstruction in this age group."
Ewing's tumor, also called Ewing's sarcoma, most often occurs in children and adolescents between the ages of 10 and 20. Bone tumors, the growth of abnormal cells in the bones, can be cancerous or not; Ewing's is cancerous. It most often develops in the arms or legs but can occur in any bone. Symptoms include pain and swelling. Treatment typically involves a combination of surgery, radiation and chemotherapy, with amputation or reconstruction also done. About 60 percent are cured.
Manfrini and his team first removed some of the girl's cancerous thighbone and then transplanted her calf bone, keeping the blood supply intact, to create a new thigh bone. This transplant was inserted into a large piece of donor thighbone that was cut and shaped to fit. The new construction was held in place with small screws and a long titanium plate.
Main muscles were all reattached to the newly fashioned joint.
After four months, the girl exercised on a stationary bike, and by nine months she had active movement of the hip. At the time of the report, four years and five months after the reconstruction, the girl is disease-free, the authors note.
The graft grew lengthwise and cross-sectionally. The head of the thighbone also grew.
The researchers did a medical literature search and did not find any reports of the type of reconstruction they did in large joints of the lower limb.
The report is called "fascinating" by a medical oncologist familiar with the problem of Ewing's sarcoma.
"It's a remarkable kind of treatment," says Dr. Herman Kattlove, a medical oncologist and medical editor for the American Cancer Society. "What they did is almost miraculous. They had to keep the blood supply intact. The surgeons must be very skilled."
However, he adds a caveat: "We need to wait and see how it all turns out. I suspect she will need a hip replacement when she becomes full size. But still, she has a functioning leg for now and that is a plus." And hip replacement surgery, these days, is routinely done, he says.