Limb preservation

Avascular necrosis, also known as osteonecrosis, can be extremely debilitating. It usually stems from a history of alcoholism, significant joint trauma or chronic steroid use for the management of systemic diseases.

Our orthopedic and plastic surgeons offer procedures to manage osteonecrosis of the hip, knee, ankle, shoulder and elbow.

These surgical options include:

• Allograft transplant
• Core decompression
• Custom titanium cage implantation
• Joint fusion
• Joint replacement
• Joint resurfacing procedures
• Stem cell grafting
• Vascularized bone flaps

We provide surgical treatment options using the latest innovations in bone-healing technologies. We combine this with time-honored approaches to provide the best options for people with bone-healing problems.

Our bone-healing treatment options include:

• Allograft bone transplantation
• Custom titanium cage implantation
• Deformity correction (for crooked bones and/or short bones)
• Internal and external fixation options
• Stem cell grafting
• Vascularized bone grafting

Reattaching an amputated body part (replantation) is a complex process that can take four to 12 hours to complete. In these situations, our plastic surgeons are experts at managing the damaged nerves, blood vessels and muscles that must be addressed to provide a positive outcome for you.

Our extremity replantation program provides:

• Access to a certified hand therapist for immediate postoperative care after reattachment
• A team of plastic surgeons, orthopedic surgeons and vascular surgeons for extensive upper extremity trauma
• A referral system coordinating transport to our facility
• Replant surgeons provide phone consultations to the referring physician and patient for management decisions prior to transport to our facility

Our mangled-extremity program is a referral-based system. It is useful if you are medically stable following significant trauma that has resulted in a complex extremity injury.

This limb salvage surgery program focuses on treatments such as:

• Internal and external fixation options
• Early soft-tissue coverage
• Fracture stabilization
• Management of infection
• Restoring lost segments of bone
• Vascularized bone and soft tissue

We offer percutaneous pelvic stabilization, an advanced surgical technique for pelvic stabilization in for pelvic deterioration due to bone cancer and/or radiation therapy. This is a revolutionary surgical option that offers a better quality of life if you have lost mobility and endure pain due to diseased or irradiated bone.

While undergoing treatment for pelvic deterioration, your treatment plan may include:

• Bone cement augmentation to areas of osteolysis (bone degeneration)
• Orthopedic screw stabilization
• Tumor ablation

To find out if you may be a good candidate for pelvic stabilization, please call our patient navigator at (800) 262-5462.

Our doctors are known for their expertise in the management of adult and pediatric extremity tumors, including bone or soft tissue sarcomas. We also treat metastatic tumors to the bone.

When treating bone and soft tissue tumors, our approach to care focuses on “life over limb.” However, we offer many advanced limb options and therapies, such as intra-arterial chemotherapy for sarcomas.

Physicians on our team have pioneered some of these innovative treatments, such as:

• Allograft procedures
• Custom implant designs
• Foam metal technologies
• Growing prostheses for children
• Soft tissue reconstruction options

When amputation is chosen to address a persistent limb problem, we are with you through the entire treatment process. This includes guiding you through your specific procedure, recovery, rehabilitation, prosthetic fitting and any psychological concerns.

Procedures and components of our amputation program include:

• Advanced prosthetic technology
• Ertl-type amputations
• Transition from traditional to Ertl-type amputations
• Osseous integration technology
• Prostheses and orthotics
• Residual limb lengthening
• Support groups for patients considering amputation
• Targeted muscle reinnervation

Osseointegration, also known as direct skeletal fixation, is a dramatic and critical advancement for individuals who struggle with their above-knee prosthesis fit and function. This approach allows for a metal fixation device to be integrated into an individual's residual femur and be connected directly to a prosthesis through an aperture in the skin. This provides a direct connection between you skeleton and prosthesis, which improves prosthesis control, eliminates socket issues and allows for direct feedback from the ground.

Our multidisciplinary team is led by a renowned orthopedic oncologist and a prominent plastic surgeon. This means our amputation program provides critical advancements and quality of life improvement for you.

When a limb is amputated, you may experience chronic limb pain from the severing of nerves during the procedure. To reduce this pain and restore your quality of life after amputation, we offer an advanced procedure called TMR.

With this procedure, surgeons meticulously reconnect each cut nerve to a nearby muscle nerve. By giving these nerves a place to transmit their signals, the formation of neuromas is minimized and patients report reduced pain, including phantom limb pain. You may also have better control of your prosthesis after the procedure.

We offer both primary or acute TMR (performed at the time of amputation), and secondary or delayed TMR (performed after a previous amputation). The procedure may be performed on either upper or lower extremity amputations.

Upon discharge from the hospital, you will meet with your care team to discuss monitoring your health at home. The team will review available resources with you, including the Limb Preservation Foundation, the Amputee Coalition and Friends of Man, to aid in their recovery and return to daily routines.