Surgery to remove a limb for bone cancer (amputation)

What is amputation?

Amputation means removing a part of the body completely. Usually, the surgeon removes part of an arm or leg rather than the whole limb.

Sometimes amputation is extremely major surgery and involves removing a leg and its hip joint and pelvis, or an arm and its shoulder. These operations are called hindquarter or forequarter operations. A surgeon will only do this if there is no other option to clear the cancer.

It can be devastating news to be told that you must lose an arm or leg. But this might be the only way to try to cure your cancer.

Why you might need an amputation

You might need to have an amputation rather than limb sparing surgery if:

• the cancer has grown into the major nerves and blood vessels around your bone tumour

• you developed an infection after your limb sparing surgery that meant the false bone had to be removed

• the position of the tumour means that limb sparing surgery is not technically possible

• it is not possible to completely remove the cancer with limb sparing surgery

Getting ready for your surgery

You meet your surgical team before your surgery. The surgeon talks to you about the risks and benefits. They ask you to sign a consent form. This is a good time to ask all the questions you need to.

Read more about what happens before your operation

What happens

You have the surgery in an operating theatre. Before you go you need to put on a hospital gown. Your nurse takes you to the operating theatre. You have a small tube (cannula) put into a vein in the back of your hand. Your ​anaesthetist​ gives you the ​anaesthetic​ medicine through the tube and you go to sleep. 

Your surgeon removes part or all of your arm or leg.

Read more about what happens on the day

After surgery

Immediately after surgery you go to the recovery room. You will have one to one nursing care. The nurse looks after you until you are awake and well enough to go back to the ward or high dependency unit.

You’ll initially have an oxygen mask over your nose and mouth. Or you may have oxygen through 2 small plastic tubes that rest in each nostril (nasal prongs). You may have several other different drains and tubes in place after having an amputation. Your nurse will explain what they are for.

You might have:

• drips to give you medicines and fluids until you are eating and drinking again

• tubes into your neck or arms to measure your blood pressure

• a drain coming from the wound

• a tube into your bladder (catheter) to collect and measure the urine you pass

• leads connected to sticky pads to check how well your heart is working

• a fine tube into your back that goes into your spinal fluid (epidural) to help relieve pain

The remaining stump of your limb is covered with tightly fitting bandages when you wake up. This maintains the shape of the stump. It also helps to make sure your artificial limb (prosthesis) will fit well.

Once the stump has healed, you will have an artificial (prosthetic) arm or leg fitted. A prosthetist will visit you before and after your operation. They will explain the types of artificial limbs you can have and to take measurements.

They make a plaster cast of your stump. Then, they use the cast and sometimes computer assisted design (CAD) to create an artificial limb that fits over the stump. They work with you to adjust the prosthesis so that it works as well as possible.

Your surgeon gives the nurses and physiotherapists very detailed instructions about your recovery. Physiotherapists, nurses and other health professionals will help you after your amputation. This includes living with your new prosthesis, physiotherapy and rehabilitation.

Read more about what happens after surgery for bone cancer

Possible risks after an amputation

You are at risk of getting an after any operation, This is a particular risk for people having chemotherapy. This risk of infection includes areas such as your wound, chest or urine infection. Your surgical team will do all they can to prevent infection. You have antibiotics during and after your operation, to try to reduce the risk of an infection.

Tell your doctor or nurse if you have any symptoms of infection.

They include:

• a high temperature

• shivering

• feeling hot and cold

• feeling generally unwell

• cough

• feeling sick

• swelling or redness around your wound and your wound might feel hot

• a strong smell or liquid oozing from your wound

• loss of appetite

Phantom limb sensation or pain

It is common to get phantom limb sensation or pain after amputation. It might feel like your limb is still there. These sensations vary from person to person. Some people feel pain such as tingling, burning, itching and cramping. Most people find that this eases off after a while. Some people have more long term problems with phantom limb pain. If you experience this, discuss this with your doctor. They can prescribe a certain type of painkiller that helps with nerve pain.

Blood clots

Blood clots (deep vein thrombosis, DVT) are a possible complication of having surgery. This is  because you might not move about as much as usual. Clots can block the normal flow of blood through the veins. Let your doctor or nurse know if you have an area in your leg that is swollen, hot, red or sore.

There is a risk that a blood clot can become loose and travel through the bloodstream to the lungs. This can cause a blockage in the lung. This is known as a pulmonary embolism. Symptoms include:

• shortness of breath

• chest pain

• coughing up blood

• feeling dizzy or lightheaded

To prevent clots it's important to do the leg exercises that your nurse or physiotherapist taught you. Your nurse might also give you an injection just under the skin to help lower the risk whilst you are in hospital. You might need to carry on having these injections for 4 weeks, even after you go home. This depends on the type of operation you had.

Your nurse might teach you to do these injections yourself before you go home. Or a district nurse might come to your home to do them.

It's important to continue wearing compression stockings if you have been told to by your doctor.

Bleeding

There is a risk that you will bleed after your operation. The team looking after you will monitor you closely for signs of bleeding. The treatment you need depends on what is causing the bleeding and how much blood you lose. You might need a blood transfusion.

Other risks

There are other risks of having an amputation. Your doctor will talk them through with you.

Your doctors will make sure the benefits of having surgery outweigh these possible risks.

Follow up

At your first follow up appointment, your doctor:

• gives you the results of the surgery

• examines you

• asks how you are and if you've had any problems  

This is also your opportunity to ask any questions. Write down any questions you have before your appointment to help you remember what to ask. Taking someone with you can also help you to remember what the doctor says.

How often you have follow up appointments depends on the results of your surgery. Ask your doctor how often you need to have these and what they will involve.

Your feelings

Having an amputation can be very difficult to cope with. Psychological support is very important. 

How you look is an important part of your self esteem. It can be very hard to accept sudden changes in your looks that you are not happy with.

There are people that can support you. For example, you can ask your doctors and nurses about the support services available to you. There are also support groups and organisations that may be able to help you.

Get tips for coping with life after bone surgery