Limb preservation at Presbyterian/St. Luke's Medical Center

Institute for Limb Preservation in Denver

The Institute for Limb Preservation at Presbyterian/St. Luke's Medical Center provides a multidisciplinary team of limb specialists. Our team specializes in the management of complex extremity conditions and treatment of conditions and diseases that place patients at risk of losing a limb.

For more than 30 years, this group has established itself as the Rocky Mountain region's premier medical community to evaluate and treat diseases and traumatic injuries of the extremities.

The history of our limb preservation program

The Institute for Limb Preservation (formerly known as the Denver Clinic) was established at Presbyterian/St. Luke’s Medical Center by Ross Wilkins, MD and Thomas Arganese, MD in 1986. Prior to its existence, patients needed to visit a variety of physicians and facilities to receive the necessary treatments.

Under the innovative orthopedic model of Drs. Wilkins and Arganese, plastic surgery, oncology, radiology and infectious disease treatment could be conveniently found under one roof.

Thanks to this model, which serves as a prototype for many programs throughout the world, patients with life- and limb-threatening cancers and diseases now have a 90 percent survival rate and a 95 percent limb preservation rate.

Our limb specialists and multidisciplinary team

Our team of experts includes specialists in orthopedic surgery, vascular surgery, oncology, infectious disease, plastic surgery and pediatric subspecialties. This group of physicians manages complex extremity conditions with a collaborative approach to care, which includes:

• Advanced treatments with proven success based on clinical research
• Active involvement in outcome studies, publications and presentations at worldwide medical conferences
• Full-time referral coordinator to assist patients with referrals, appointments, transportation and lodging
• Patient navigator as a central point of contact for limb-threatening diagnoses

Our limb preservation services

The collective experience and specialized knowledge of our limb preservation team allow us to treat the full spectrum of limb conditions, diseases and injuries. As part of that treatment, we offer several specialized programs that provide medical management and support to each patient throughout the duration of their care.

Avascular necrosis program

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 provide surgical options 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

Bone-healing program

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

Extremity replantation program

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 each patient.

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 patients with extensive upper extremity trauma
• A referral system coordinating patient transport to our facility
• Replant surgeons providing a phone consultation to the referring physician and patient for management decisions prior to transport to our facility

Mangled-extremity program

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

This 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

Pelvic stabilization

We offer percutaneous pelvic stabilization, an advanced surgical technique for pelvic stabilization in patients who have pelvic deterioration due to bone cancer and/or radiation therapy. This is a revolutionary surgical option that offers a better quality of life to patients who 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.

Sarcoma (bone and soft tissue tumors) program

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 patients with metastatic tumors to the bone.

When treating bone and soft tissue tumors, our approach to patient care focuses on “life over limb.” However, we offer many advanced limb-sparing surgical 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

Amputation program

When amputation is chosen to address a persistent limb problem, we are with our patients through the entire treatment process. This includes guiding the patient through their 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 of traditional to Ertl-type amputations
• Osseous integration technology
• Prostheses and orthotics
• Residual limb lengthening
• Support groups for patients considering amputation
• Targeted muscle reinnervation

Osseointegration provides amputees with increased quality of life

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 the patient's skeleton and their prosthesis, which improves prosthesis control, eliminates socket issues and allows for direct feedback from the ground. Renowned orthopedic oncologist, Daniel Lerman, MD and prominent plastic surgeon, David Schnur, MD lead a multidisciplinary team at Presbyterian/St. Luke's Medical Center's amputation program, providing many amputees a critical advancement and quality of life improvement.

Targeted muscle reinnervation for limb pain

When a limb is amputated, some patients may experience chronic limb pain from the severing of nerves during the procedure. To reduce this pain and restore a patient's quality of life after amputation, we offer an advanced procedure called targeted muscle reinnervation (TMR).

With TMR, 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. Patients also may have better control of their prosthesis after TMR.

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.

Limb preservation resources

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