Restoring Limb Length Following Bone Cancer Surgery

Limb lengthening

Following surgery and chemotherapy for a malignant bone cancer in her arm (Ewing’s sarcoma), a 10-year-old girl wearing an external fixator as part of our limb-lengthening technique experienced nearly six inches of bone growth over the course of several months. Now in full remission, the patient is unlimited in terms of her sports and other activities, as the bone has subsequently filled in completely.

When people with bone cancer in an arm or leg undergo surgery, doctors typically offer one of two options: replace the tumor with either a piece of metal or a section of cadaver bone.

But while these materials can often help keep the limb useable, they are far from ideal and often get infected, wear out, or pose other complications as the body’s immune system adjusts to the unfamiliar tissue.

A solution that orthopaedic surgeon Daniel Prince now offers at Memorial Sloan Kettering requires a small — but literal — leap of faith.

“With this relatively novel approach to limb lengthening, we take advantage of the fact that bone is one of the few organ systems in the body that is able to heal itself by regenerating bone that’s just as strong and healthy as normal bone,” he explains. “We give people back their own bone by tricking it into thinking there’s a fracture, so it makes new bone to jump across and seal the gap.”

We give people back their own bone by tricking it into thinking there's a fracture, so it makes new bone to jump across and seal the gap.
Daniel Prince Orthopaedic Surgeon

How It Works

The technique was originally developed about 50 years ago and has been widely used for restoring limbs in infants with congenital growth problems and correcting improperly healed bone fractures in adults.

But it has only recently been tested in oncology, and mostly for repairing small bone defects in people who don’t need chemotherapy.

MSK is now able to treat people with longer bone defects and patients who may also need chemotherapy. The method is ideally suited to restoring the limb after tumor removal. “Currently, this isn’t done regularly in the United States for people with cancer,” says Dr. Prince, who practiced the technique in Florida for several years before bringing it back to MSK, where he had done his fellowship training.

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The Four-Month Surgery

Dr. Prince describes the technique as “four-month restorative surgery” because the actual changes occur after the procedure, while the patient is recuperating, rather than in the operating room.

During the operation to remove the cancer, surgeons cleanly cut the bone and install a device — in most cases on the outside of the limb — that holds the bone very still. In the months following the surgery, the patient or caretaker makes very small adjustments each day to this external device based on a schedule that Dr. Prince provides.

“Every day, depending on how much we need, we increase that gap and so we keep tricking the bone into thinking, ‘Oh, there’s a fracture I need to heal.’ The bone cells jump across the gap, and then we move it again,” he explains. “Then it jumps across again — and we move it again. When we move it at a millimeter a day, the effect can be dramatic.”

Over the past 12 years, Dr. Prince and others using the technique in people with cancer have helped nearly 40 people worldwide lengthen a limb following surgery to remove a tumor.

He says the external device can initially cause pain because it’s attached to the bone through the skin, but after a few days the daily adjustments are painless because they are so minimal. And with the external fixator in place, patients are usually active after three weeks or so — even going to the gym, swimming, and going back to work — while the bone is doing its lengthening work.

Visits to the doctor’s office are needed every couple of weeks. “It’s a very intensive process. A lot of things can come up that we want to address right away, such as adjustment or replacement of the pins,” Dr. Prince says.

The ideal candidates for the procedure are children, he says, because they make bone so quickly. But it is not just for children; limb-lengthening for adults with cancer is also increasing. “As long as you’re alive, you have this ability — this innate ability — to heal broken bones,” he says.

“Our goal at MSK is not just to treat patients for their cancer, but to move beyond even that — we want you to have the best function and quality of life possible after your cancer is cured so you can get back to a full, healthy life.”

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I'm an Osteosarcoma patient with right leg limb salvage surgeries by Dr's Healey and Boland. I have a stubborn Osteomyelitis. Am I a candidate?

Arthur, thank you for reaching out. To find out whether you are a candidate for this treatment you would need to consult with a Memorial Sloan Kettering physician. You may call our Physician Referral Service at 800-525-2225 or go to Thanks for your comment.

Had my lower left leg lengthened by 2.5" via the Ilizarov method - after some traumatic terrorist-induced injuries in the Middle East. Due to poor interim care in the M.E. before repatriation (deficient wound debriding of debris), I had bad chronic osteomyleitis (infection) and needed some shards of spinting hipbone via an autologous transplant. It worked like magic (no limp whatsoever) - despite the leg having been shattered. Up to the point where I elected Ilizarov, the only option was amputation. Probably shouldn't mention the Perth WA specialist's name, but he's well-known worldwide (initials D.S.). The Ilizarov technique is orthopod magic IMHO. Invented by Russki Prof Ilizarov and first employed on Russian soldiers in WW2.

My daughter is being treated by Dr. Prince currently. He saved my daughter's femur (osteosarcoma). He gave us the best option for her by sparing her own limb instead of having to have prosthetics. So happy we found him!

Dear Pam, we are glad to hear that your daughter has been well-cared for by Dr. Prince and his team. Thank you for sharing your thoughts and experience on our blog!

My son has limb salvage surgery on his left posterior femur in December 2015. He has a titanium rod in his leg. Would he be a candidate down the road, or should I say, would his bone regenerate at this point?

Hi Dawn, we sent your question to Dr. Prince, who said that bone can be regenerated even many years after tumor removal. Often our surgeons perform regenerative surgery as a reconstruction when other methods have failed. But he said without knowing more details about your son’s case, it’s not possible to say if he’s a candidate for this procedure. Every patient needs to be evaluated on an individual basis. If you’d like to make an appointment to have your son seen by one of our surgeons, you can call 800-525-2225 or go to for more information on making an appointment. Thank you for your comment.

My son was diagnosed with osteosarcoma back in September 2016. He is been reciving chemotherapy treatment since October. His tumor is in his left upper tibia close to the knee. Surgeon wants to perform the surgery first week on February 2017 to remove the tumor. The best option given for my son was expandable prosthesis. Although the tumor is on the tibia, surgeon says he needs to remove my son's knee as well. I am very concern about that and would like to know if my son can be a candidate for the new approach. Thank you.

Dear Mary, we’re sorry to hear about your son’s diagnosis. If you’d like to arrange for an appointment at MSK to find out about whether your son would be an appropriate candidate for this treatment, you can call 800-525-2225 or go to for more information on making an appointment. Thank you for your comment, and best wishes to you.

Great Dr. Today he did hip replacement on my sister. His bedside manner as a doctor is unlike any I've met. He is very patient. Has a good sense of humor. He explained everything in details. I thank you Dr. Prince for the way you pratice your craft! MSKCC patients are lucky to have you. My sister jokingly said you were her prince charming before she even met you for a consultation and you proved that right. Today you have given my family and I a new begining. A hope for change. God bless you!

Dear Pierrette, we are so happy to hear that your sister is doing well and that she had a good experience with Dr. Prince. We will forward your message to him. Thank you for your comment!

My daughter 15 year sold was under endoprostesis reconstruction, in Sep 28 2017, in sick kids Toronto. Beside she got some lesion in her lung 3 months after last post operation chemo, she has good nativity and movement, doing swimming etc.. We have tole she may need changing prosthesis after couple of years, is that any chance to apply this procedure on her, on that time? Best regards

Dear Mehrdad, we’re sorry to hear your daughter is going through this. If you would like to bring her to MSK for a consultation, you would need to go through our International Center, since you live in Canada. The email address is and you can go to for more information. Thank you for your comment, and best wishes to you and your family.

Dr Prince and his team are wonderful. He does remarkable work and puts much thought into how he can best help the patient as an individual in line with their own diagnosis. Being presented with our child's daunting diagnosis of Ewing Sarcoma, he gave us the best option for surgery with the bone lengthening. It took work and time but we feel we made the best choice with this option. Dr Prince was there the whole way. We are truly thankful for his skill and care as a surgeon. We will always be part of team regeneration. MSK is at the forefront in terms of protocol and care.