Orthopaedic Oncology

Orthopaedic cancers start in or travel to bone, muscle, or soft tissue. MedStar Health orthopaedic oncologists are leaders in the surgical advances and innovations to treat this type of cancer, including limb-sparing surgery, a modern technique that can save an affected arm or leg and avoid amputation.

At The National Center for Bone and Soft Tissue Tumors at MedStar Franklin Square Medical Center, we offer a comprehensive approach to treating these rare tumors, incorporating every resource we have to ensure our patients receive the best treatment available. Working with patients, their families, and referring physicians, our dedicated specialists provide expert guidance and support throughout the diagnosis and treatment process. Because of our experience, we frequently perform complex and revision surgeries referred from other medical centers in the country.

In addition to our advanced and compassionate clinical care, we have a highly successful, accredited fellowship training program and educate students and residents with an emphasis on our surgical services and research.

Learn more about orthopaedic cancer, including: 

 

Types of Orthopaedic Cancer

Benign Orthopaedic Tumors

Benign orthopaedic tumors put pressure on healthy tissue but do not spread. They pose minimal risks and are considered non-cancerous. Some childhood benign tumors, such as bone cysts, may fully resolve over time as the bone matures with age.

Other benign bone tumors are considered more aggressive and require additional care. These include:

  • Giant cell tumors occur around the knee or the ends of long bones and can quickly damage the bone. These tumors tend to affect young adults.
  • Chondroblastomas occur at the very ends of the long bones in the arms or legs and can damage the growth plate or joint surfaces. These tend to occur in children.
  • Aneurysmal bone cysts cause the bones in the arms, legs, trunk, or skull to expand dramatically. These tumors tend to affect children and younger adults and can damage bone and often grow back.
  • Osteoid osteomas may occur anywhere in any bone and are typically extremely painful, due to chemicals released by the tumor into the the surrounding nerves.

Treatment

Giant cell tumors, chondroblastomas and aneurismal bone cysts are often treated with the same therapy, including a combination of:

  • Curettage, where the tumor or cyst is scraped out during a surgical procedure
  • Cryosurgery, where the tumor or cyst is frozen with liquid nitrogen and destroyed
  • Reconstruction, where the remaining bone is repaired with metal rods, cement and bone graft

Osteoid osteoma is often treated with:

  • Surgery
  • Radiofrequency ablation

Sarcomas

Sarcomas are tumors that occur in bones or soft tissue such as muscles, fat, and nervous tissue, and are distinguished by the type of tissue from which they originate.

Bone Sarcomas

  • Primary tumors originate in the bones (less common than many other cancers that spread, or metastasize, to bone)
  • Secondary tumors begin in a different part of the body and spread to the bones. Primary bone tumors are.

Common bone sarcomas include:

  • Osteosarcoma, which forms osteoid or hard bone tissue, is the most common form of bone sarcoma, found in about 35 percent of cases. While it may occur at any age, it tends to affect children in late adolescence and appears most commonly around the knee.
  • Chondrosarcoma, which forms cartilage tissue, is found in about 30 percent of cases. It tends to affect adults older than 40, and appears in the hip, pelvic, and shoulder areas.
  • Ewing's Sarcoma, which develops in the lungs, bone or the pelvis, arises from cells of unknown origin. It tends to affect children younger than age 19, and appears in the legs and arms. It is more common in boys than girls.

Risk Factors

Certain conditions, as well as exposure to certain chemicals, put people at higher risk for developing bone sarcomas, particularly osteosarcoma. These include:

  • Hereditary conditions, including a rare childhood eye cancer called hereditary retinoblastoma, and hereditary bone diseases, such as enchondromatosis and osteochondromatosis
  • Prior radiation exposure
  • Treatment with anti-cancer medications

Symptoms

As a sarcoma begins to develop, there may be no noticeable symptoms. However, over time, patients may feel:

  • Persistent pain
  • Swelling
  • A bump or mass where the tumor is located

Diagnosis and Treatment

Your doctor can detect the presence of a bone sarcoma in the following ways:

  • History and physical examination: This includes feeling and looking at the area of pain, as well as gathering information about family medical history.
  • Imaging tests help to determine a tumor's size, shape, location and whether a tumor is benign or malignant. Imaging tests include:
    • X-rays, CT and PET scans, and MRI
    • Angiogram: creates a picture of the interior of the blood vessels
    • Bone scan: a doctor injects and then tracks a radioactive substance through the blood. A scanner can detect the substance's route once it settles in the bones.
  • Blood work: tests for levels of alkaline phosphatase. This chemical in the blood may be higher than normal because of tumor growth in the bone tissue.
  • Biopsy: your doctor collects a tissue sample from the affected area to identify the exact type of tumor

After examining the results of one or more of these tests, your doctor will tell you if you have a bone sarcoma and will always answer any questions you have. MedStar Health also has compassionate patient support services for newly diagnosed patients.

Many patients will have success from a combination of treatment types. Each patient undergoes a thorough evaluation to determine the most effective course of treatment, which include

Soft Tissue Sarcomas

Soft tissue sarcomas are rare cancerous tumors that can grow in muscle, fat, nerves, and blood vessels, and they are distinguished by where in the body they originate. About half of all soft tissue sarcomas affect the arms and legs, while the rest appear in the head, neck, or trunk. Regardless of where they begin to grow, soft tissue sarcomas tend to present with similar characteristics and symptoms, and are treated the same way.

Types

  • Fibrosarcoma: Develops from the tissues keeping bones, organs, and muscles secure and appears most often in the legs, arms, and trunk.
  • Hemangiosarcoma: Develops from the blood vessels in the arms, legs, head and trunk.
  • Leiomyosarcoma: Develops from smooth muscles used to control the movement of internal organs and blood vessels. These tumors tend to affect adults.
  • Liposarcoma: Develops from fatty tissues, and appears most often in the legs and trunk.
  • Lymphangiosarcoma: Develops from the lymph vessels, and appears in the arms. It tends to affect tissues that may have been exposed to radiation.
  • Malignant fibrous histiocytoma: Develops within muscle or fat, most often in the thighs and trunk. It tends to affect older adults.
  • Neurofibrosarcoma: Develops from nerves, and appears most often in the legs, arms and trunk.
  • Rhabdomyosarcoma: Develops from skeletal muscles used to move bones. It tends to affect young children, and appears most often in the arms and legs.
  • Synovial sarcoma: Develops from tissues that cushion the joints, such as knees and elbows. It tends to affect children and adolescents.

Risk Factors

Certain conditions, as well as exposure to certain chemicals, put people at higher risk for developing soft tissue sarcomas. These include:

  • Hereditary conditions, including a rare childhood eye cancer called inherited retinoblastoma, Li-Fraumeni syndrome, Gardner's syndrome, and a nerve tissue disorder called neurofibromatosis.
  • Radiation exposure, specifically when used to treat other cancer types.
  • High dose chemical exposure to
    • Vinyl chloride, an ingredient in plastic
    • Phenoxyacetic acid, an ingredient in certain herbicides
    • Chlorophenols, an ingredient in wood preservatives
    • Arsenic

Symptoms

As the soft tissue sarcoma develops, patients may feel a lump. These sarcomas often do not cause pain or swelling, so it is important to have a doctor examine any lump that lasts a long time.

Diagnosis and Treatment

Your doctor can detect the presence of a soft tissue sarcoma in the following ways:

  • History and physical examination: This includes palpating (feeling) the tumor mass. as well as gathering information about family medical history.
  • Imaging tests help to determine a tumor's size, shape, location and whether a tumor is benign or malignant. Imaging tests include X-rays, CT and PET scans, and MRI

After examining the results of one or more of these tests, your doctor will tell you if you have a bone sarcoma and will always answer any questions you have. MedStar Health also has compassionate patient support services for newly diagnosed patients.

Many patients will have success from a combination of treatment types. Each patient undergoes a thorough evaluation to determine the most effective course of treatment, which include

Learn more about orthopaedic cancer treatment.

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Patient Stories

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Sports Medicine

MedStar Orthopaedic Institute

There are 206 bones in the adult human body, plus all the associated muscles, ligaments and joints. Most of the time, they work in tandem like a finely calibrated machine. But things can go wrong, sometimes in remarkably complicated ways. That’s why the MedStar Orthopaedic Institute should be your first choice for care.

Our network of skilled specialists provides the innovative solutions you need for the entire spectrum of orthopaedic conditions. Hand treatments. Spine care. Sports injury. Hip surgeryKnee replacement. No matter what problem you’re facing, you’ll benefit from the latest in diagnostic services, surgical and nonsurgical treatments, and outpatient rehabilitation therapies. And no matter how complex the surgery or care you need, we provide it in a compassionate environment, close to wherever you live, work or play.

The MedStar Orthopaedic Institute combines the expertise of dozens of specialists—including fellowship-trained experts—from MedStar Georgetown University Hospital, MedStar Montgomery Medical Center, MedStar St. Mary’s Hospital and MedStar Washington Hospital Center. Working together in this advanced network of care, your dedicated team will develop and carry out the course of treatment that’s best for you.

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Concussion Testing

Baseline Concussion Testing

The MedStar Sports Medicine Concussion Program recommends athletes take a baseline neurocognitive assessment as part of a pre-participation physical exam.

If you play sports, it makes sense to have baseline test results on file in the event of a concussion. The MedStar Sports Medicine Concussion Program uses ImPACT testing, which is a computerized program that evaluates how a brain functions. Baseline test results can be compared to post-injury test results and help clinicians determine the extent of any injuries and when normal activity can be safely resumed.

We are available to administer the baseline testing on-site for groups or teams, and individual testing is conducted in a number of convenient locations throughout the central Maryland and Washington, D.C. regions.

To schedule baseline testing, call 855-463-3318.

Post-Concussion Testing

MedStar Sports Medicine specialists use the results of post-concussion testing to develop an individualized concussion management program to monitor and track your recovery. The post-concussion program provides a state-of-the-art, medically based plan with clear guidelines to support timely and safe return-to-play and appropriate accommodations for school or work.

Sports Injury Prevention and Treatment

sports injury

The sports medicine specialists at the MedStar Orthopaedic Institute have experience diagnosing and treating nearly every type of sports injury and condition, from the most common to those that are incredibly rare. Since no two patients have the same needs, our physicians take the time to design an individualized sports injury treatment plan for your specific case.

Our team of sports medicine physicians offers comprehensive care and treatment for all of your sports injuries, whether you’re a weekend warrior, play on a team or just enjoy some occasional exercise. Our experts are at the forefront of advanced therapies and minimally invasive procedures, giving you early access to new treatments. Our goal is to return you to the activity level you desire as soon as possible, with the least chance of reinjury.

We also offer numerous programs and services for those athletes or active individuals who are interested in sports injury prevention or are looking to enhance their sports performance, skills and abilities. Some of those programs and services are below.

Golf Performance Enhancement

The golf performance evaluation is a comprehensive physical examination performed by a licensed physical therapist specializing in techniques from Back to Golf©, Kinetic Golf© and Body Balance for Performance©. Our therapists are experienced in sports-specific training programs, functional stabilization, conditioning, and kinesiology. They also have sports medicine experience treating golf-related sports injuries and rehabilitating athletes at all levels of performance.

Evaluations include video motion analysis, testing and measurements of:

  • Posture
  • Balance
  • Flexibility
  • Strength
  • Core stability
  • Conditioning

The information gathered from the evaluation is used to design a customized, golf-specific physical training program that will optimize your strength and improve the physical characteristics necessary to swing a golf club properly. The goal of the program is to achieve maximum distance, accuracy, control, and scoring potential while decreasing injury risk.

In addition to individual evaluations performed in our clinics, we give educational presentations to teams and golfing groups.

Nutrition

Proper nutrition is key to an athlete's success. Specific diets rich in differing ratios of carbohydrates, proteins, fats, and sugars are recommended for specific athletic events. For example, athletes in endurance sports generally do better with a high-carb, low-protein diet, while sports requiring incredible strength call for more protein. As a patient of the MedStar Orthopaedic Institute, you have access to the expertise of registered dietitians to assist with developing a proper diet specific to your physical needs and the sports you play.

Orthotics

Orthotics devices worn in your shoe can realign your foot and reduce some of the sports injuries that begin at the foot and travel upward. Because your feet are your body's main shock absorbers, a number of sports injuries and conditions can arise when your feet are compromised. If used properly, orthotics can absorb the shock, reducing the risk of injury. The experts at the MedStar Orthopaedic Institute offer complete prosthetic and orthotic services for adults, adolescents and children.

Personal Training

At the MedStar Orthopaedic Institute, we take a balanced approach to fitness by developing a customized exercise program designed to meet your specific sports injury prevention or treatment needs and goals. Many of our patients have medical issues, and we highly encourage them to continue exercising following discharge from therapy to achieve better health.

Our trainers are certified through the National Strength and Conditioning Association and have experience working with a wide range of physical limitations that restrict patients' ability to exercise.

Services—including yoga, general fitness and post-rehabilitation for breast cancer patients—are provided at several locations and may also be arranged at your home or gym.

Platelet Rich Plasma Treatments

Platelet Rich Plasma (PRP) is a sports injury treatment option that uses your own blood to facilitate healing. Essentially, specialists using this technique draw your blood and separate out the platelet portion. Platelets have been shown to release healing proteins called growth factors that work together to coordinate tissue healing. By injecting a high concentration of platelets into injured soft tissues, physicians intend to speed up the healing process.

Much work remains to be done in exploring the application and utility of PRP. Our regeneration lab at the MedStar National Rehabilitation Hospital has recently been awarded a grant to explore the application of PRP in shoulder tendinopathies. This and future studies will provide great insight into this promising sports injury treatment, paving the way to a better understanding of common and disabling sports injuries.

Return-to-Play Program

The MedStar Orthopaedic Institute offers a research-based evaluation to assist athletes in their return to full competition. The program uses video motion analysis software and objective criteria to determine if you are functionally ready to return to play. The scientifically based testing identifies deficits in strength, power and/or biomechanics that increase your risk of lower-extremity sports injury. Participants in the program also receive a comprehensive exercise program to address those deficits and are instructed in proper jump-landing mechanics until you can pass the return-to-play criteria.

Running Injury Clinic

MedStar National Rehabilitation Network's Running Injury Clinics combine highly skilled therapists with cutting-edge technology. More information is available here.

Soccer Performance Enhancement

The MedStar Orthopaedic Institute specializes in individualized programs for youth, collegiate and professional level athletes, as well as casual weekend sports participants. Our goal is to enhance the conditioning, human performance, sports injury prevention, and participation ability of athletes who are interested in achieving their greatest potential.

The MedStar Health Performance Enhancement Program for Soccer is a comprehensive six-week program. Our professional staff of physical therapists, certified strength and conditioning specialists, and licensed soccer coaches train the athletes three times a week. The sessions are 75 minutes each, with an exceptional ratio of trainers to athletes ensuring individualized attention for proper technique and safety. The program is designed to:

  • Improve soccer-specific strength and conditioning
  • Increase power, speed and agility through plyometrics (jump training)
  • Improve dynamic balance and reaction time
  • Enhance acceleration and deceleration, as well as explosive change of direction
  • Increase flexibility to prevent sports injuries
  • Provide essential nutrition and hydration information to maximize soccer performance

Throwing Clinic

It is our goal to bring the latest research in training and sports injury prevention to the baseball community. Injuries seen previously only in professional pitchers are now commonplace in players of any position in high school and younger. The great majority of these are overuse/repetitive strain injuries that could be prevented with:

  • Proper education
  • Strength
  • Flexibility
  • Conditioning

We offer throwing evaluations to prevent sports injuries and keep you in the game. Evaluations include assessment of posture, strength and flexibility for the arm, core and lower extremities. We then use those findings to customize exercise programs that will be most beneficial for each individual athlete. After completing the program, most pitchers are able to throw harder and with better control while decreasing their risk of injury and surgery.

In addition to individual evaluations performed in our clinics, we give educational presentations to camps, teams and leagues outside the clinic.

Video Gait Analysis

If you are an athlete with running injuries, Dynamic Video Gait Analysis (DVGA) may help solve your sports injury problem. The MedStar Orthopaedic Institute’s sports performance experts are able to assess problems of the foot and lower extremity that may be causing your pain or symptoms.

DVGA helps assess the following:

  • Plantar fasciitis (cause of heel pain)
  • Ankle pain
  • Shin pain
  • Knee pain
  • Hip pain
  • Low back pain

Multiple high-speed cameras identify reflective markers placed on several parts of your body, including the torso, hip, knees, and feet. These markers are a reference point for several camera angles, which pick up any abnormal movement of these joints while you run on a treadmill. Once the motion is recorded, a specialized computer software program pinpoints which joints are functioning incorrectly.

If joint alignment problems are discovered, a personalized sports medicine program is developed for the runner, which may include physical therapy for strengthening and flexibility, orthotic devices, or training and shoe modifications.

Shoulder Treatments

Shoulder Treatment

Your shoulder is one of the most widely used joints in the body, and all of the wear and tear causes many injuries. If you suffer from a shoulder injury, our top priority is eliminating the cause of your pain so you can resume using your arm with comfort and strength. The orthopedic shoulder treatment specialists at the MedStar Orthopaedic Institute dedicate themselves entirely to that priority. We care for a wide range of disorders and offer shoulder treatments and surgery options to relieve everything from a sports-related injury to a degenerative disease.

Arthroscopic Rotator Cuff Repair

The rotator cuff is made of four muscles that attach to the shoulder blade (scapula) and wrap around the front, back and top of your shoulder. Together, these muscles help guide the shoulder through many motions and also lend stability to the joint. The ends of the rotator cuff muscles form tendons that attach to the arm bone (humerus).  A variety of conditions and injuries can damage the rotator cuff, cause pain and make it difficult for you to move your arm.

In many cases, rotator cuff tears can be repaired with physical therapy and cortisone injections. However, when nonsurgical treatment does not improve your symptoms, arthroscopic rotator cuff repair may be necessary.

Arthroscopic rotator cuff repair is a minimally invasive technique, which uses an arthroscope, or thin, flexible tube equipped with a small camera. Your surgeon inserts the arthroscope through a small incision in your shoulder in order to gain access to your arm bone. The camera magnifies your injury onto a screen and allows your surgeon to visualize the damage in detail. The surgeon can then repair your tissue and restore the torn cuff to its correct position at the top of your arm bone very precisely without affecting any surrounding tissue.

Following this procedure, your shoulder will need to be immobilized in order to protect the newly placed sutures from being disrupted. After one or two weeks, you will begin physical therapy, followed by active lifting with the arm after four to six weeks. It will generally take four to six months to completely recover.

Coracoid Transfer for Shoulder Instability

If you suffer from chronic shoulder instability, you may be a good candidate for coracoid transfer surgery. This type of shoulder surgery is particularly helpful for patients who have had shoulder stabilization procedures previously or who are missing bones in the front of the shoulder socket.

In this open surgery technique, also known as the Latarjet procedure, your surgeon makes an incision at the front of your shoulder. The surgeon then transfers a piece of bone from the front of your shoulder blade to the front of your shoulder socket, helping to hold the ball in the socket of your shoulder joint and providing extra protection against continual dislocation of the joint.

Following the procedure, you may need to remain in the hospital overnight, and you may meet with a physiotherapist and/or an occupational therapist to learn appropriate exercises for your arm. You will need to keep your arm in a sling for a few weeks, and your surgeon and therapists will determine when you may return to your regular activities.

Open Bankart Repair

Used to treat conditions such as shoulder dislocations or instability, open Bankart repair helps lock the ball back into the socket of the shoulder joint. In this procedure, your orthopedic surgeon will repair damaged ligaments and cartilage through an incision in the front of your shoulder.

Following the procedure, you will start on exercises that will be provided by a physical therapist. You will be able to return to many of your daily activities quickly, but you will not be able to lift heavy objects for a couple months. If you are involved in sports, you may be able to return to training after three months, but you can typically return to low-risk activities (such as swimming or jogging) about eight to 10 weeks after surgery.

You may be a good candidate for open Bankart repair if you suffer from severe shoulder instability and have not found relief from medication, physical therapy or other nonsurgical techniques. We also often use this method to help patients who have previously had unsuccessful shoulder surgery.

Shoulder Replacement Surgery

Arthritis can make it difficult and painful to perform even the simplest daily tasks. If nonsurgical treatment options are not improving your condition, shoulder replacement surgery can mean the difference between being dependent on others and an independent life at home or in the community.

Total shoulder replacement is a surgical procedure performed by an orthopedic surgeon with special training in joint replacement. It is very effective at relieving pain and improving function. During the procedure, your surgeon replaces the damaged parts of your joints with artificial parts, called a prosthesis. The treatment options are either replacement of just the head of the humerus bone (ball) or replacement of both the ball and the socket.

You will likely be able to go home between one and three days following the surgery. You will feel some pain, but medication can help to manage it. You will need to start a rehabilitation program soon after the surgery, and your surgeon or physical therapist will help to develop a program for you.

Reverse Total Shoulder Replacement

Often, you can experience shoulder arthritis along with damage to the rotator cuff, which is the group of muscles that hold your shoulder in place and allow you to move your arm in different directions. If you suffer from both conditions at the same time, a total shoulder replacement procedure may not provide sufficient relief.

An alternative is reverse total shoulder replacement. In this open surgery, your orthopedic surgeon replaces worn away cartilage and changes the position of the ball and socket joint so you can use a different set of healthy muscles to move your arm (instead of your damaged rotator cuff muscles).

During the procedure, your surgeon makes an incision either on the front or the top of your shoulder. Your surgeon then removes the damaged bone and positions the new ball and socket joint.

You will likely return home on the second or third day following surgery. You will need to wear a sling for a few weeks, as well as complete gentle range of motion exercises. Your surgeon may recommend a physical therapy program as well. Most patients are able to regain full use of their shoulder after approximately six weeks.

Infected Total Joints

If a total joint replacement becomes infected, the health of your shoulder and arm, as well as your overall health, becomes an immediate concern.

In some cases, only the skin or soft tissues around the joint are infected, and it has not spread to the artificial joint. In this case, you may be treated with intravenous (IV) or oral antibiotics. If the infection has spread to the artificial joint, you will likely require surgical treatment, such as debridement or staged surgery.

Debridement may be appropriate if the infection is caught within the first few days. During this procedure, your surgeon removes the contaminated soft tissues, cleans the implant and replaces plastic liners or spacers. After the procedure, you will receive antibiotics for approximately six weeks.

When the infection has been present for more than a few days, staged surgery is generally needed. During the first phase of this treatment, your surgeon will remove your implant, wash the joint and soft tissues, place an antibiotic spacer to maintain normal spacing and alignment, and prescribe approximately six weeks of IV antibiotics. When the infection has been cured, your surgeon will remove the antibiotic spacer, wash the joint and reimplant your shoulder.

Preventing Shoulder Injuries

Before hitting the greens, tennis court or swimming pool, consider these tips to help prevent shoulder injuries:

  • Practice proper technique. Learn and practice the proper techniques for sports that are hard on the shoulders. For example, swimmers can help save their shoulders by placing their fingers or pinkies in the water first, not their thumbs, during freestyle.
  • Ease into exercise. Warm up with light activity such as jogging in place or jumping rope for several minutes. Then stretch your shoulders and the other muscles you'll be using. Try this shoulder stretch: Lace your fingers together and then push your arms over your head with your palms facing up. Hold for 15 seconds. Repeat five to 10 times. Be certain to also stretch after you've finished exercising.
  • Strengthen the shoulder area. Building the muscles in your wrists, arms, neck, and back helps protect your shoulders.
    • When the muscles surrounding the shoulder are strong, there's less stress on the shoulder itself. Strengthening the shoulder muscles also helps to prevent injuries. To build your shoulder muscles, grasp an unopened soup can in each hand. Point your thumbs to the ground and keep your elbows straight. Raise your arms to waist level and slowly lower them, as if you were flapping your arms. Repeat five to 15 times. Do two or three sets.

Most importantly: Do not ignore symptoms or play through a shoulder injury. Doing so can aggravate the condition and cause more problems. See a doctor if symptoms persist or if your pain is severe.