Advances in sophisticated radiological imaging, new diagnostic pathology tests,modern chemotherapy and immunotherapy advances, 3D printed custom implants and improved surgical techniques since 1983 have allowed limb-salvage surgery to become the preferred surgical treatment for bone sarcomas of the extremities. The goal of limb-salvage surgery is to maximize limb functionality to allow for the maintenance of quality of life without compromising overall survival and tumour local recurrence rates. Today, limb-salvage procedures are performed on 80–95% of patients with extremity sarcoma and it is a team effort.
The principals of tumour surgery means all the tumour should be removed with a wide or safe wide margin preserving nerve and blood vessels where possible, but this often means large surgical tissue defects to be filled by our plastic surgeon colleagues using advanced microusrgical techniques
With the advent of computerised surgical navigation by Brainlab 3D and custom implant designs, significant surgical implant and reconstructive advances have been made. Common types of surgical reconstruction techniques include navigated joint preserving surgery along with endoprostheses (EPR), intercalary or osteoarticular allografts, vascularized fibular autografts, bone transport and allograft prosthetic composites (APC) and novel reconstructive options. Professor Steadman also specialises in one of the rarer operations performed in Australia called Van Ness rotationplasty.
Anatomic locations of lesions treated by Professor Steadman include the pelvis and lower spine, proximal, midshaft and distal femur, proximal and distal tibia, ankle and foot, along with upper limb lesions of the proximal humerus, distal humerus and elbow and forearm and hand bones.
Amputation can still be indicated if the tumour is very advanced or wrapped around blood vessels and nerves, but new bone end reconstructive options such as osseo-integrated implants can optimise function.
