Limb preservation

Diagnosing your condition

Doing a thorough physical examination and analyzing your medical history are both crucial to creating the best care plan for you. We might ask you to move your affected limb or move in other ways during a physical examination. From there, running imaging and laboratory tests ensure we can get the full picture. These tests allow us to view the inside of your affected hand, arm, leg or foot. They also give us insight on other issues you might have with your bones and joints. Additionally, we use these tests to examine blood flow before, during and after your procedure, as well as to determine the success of your procedure.

The imaging and laboratory tests we offer include:

• Bone scans
• Computerized tomography (CT) scans
• Magnetic resonance imaging (MRI) scans
• Vascular testing
• X-rays

Our limb preservation treatments

We understand that limb-jeopardizing conditions can be unsettling. We address this reality by creating a personalized treatment plan that suits your unique needs. Our doctors are fellowship-trained and experienced in joint preservation and joint reconstruction procedures. We create tailored care plans in concert with leading specialists from other disciplines like plastic surgery and oncology.

Working in partnership with the Limb Preservation Foundation, we provide medical, emotional and financial support for you and your family. Additionally, the Institute for Limb Preservation at our network hospital, Presbyterian/St. Luke's Medical Center, positions us as a valuable resource. When you come to us for your care, you work with a multidisciplinary collection of specialists, including:

• Orthopedic, vascular and plastic surgeons
• Medical and radiation oncologists
• Musculoskeletal pathologists
• Physical and occupational therapists

You may see different specialists in our network if you are experiencing conditions such as sarcoma, avascular necrosis or bone infections. Our doctors excel at treating complex orthopedic and orthopedic oncological procedures. We believe in developing long-term medical relationships, keeping your goals front of mind and giving you autonomy in your care.

Nonsurgical treatments for limb conditions

In many cases, limb-related conditions can be addressed through nonsurgical means. We have a number of nonsurgical methods to treat conditions such as femoroacetabular impingement (FAI), arthritis and hip dysplasia.

Your nonsurgical treatment plan might include one or a combination of:

• Activity and lifestyle modifications
• Anti-inflammatory nonsteroidal medications
• Braces
• Clot-dissolving medications
• Injections
• Physical and/or occupational therapy
• Walking aids

Nonsurgical treatments can slow the progression of certain conditions, but they might not stop it altogether. This means surgery might ultimately be necessary. Similarly, if nonsurgical means are completely ineffective, we'll work with you to determine the best course of surgical treatment.

Limb-salvaging surgical treatments

Limb conditions require specialized treatment, and our care team works in many different disciplines. Delivering effective treatment requires the ability to treat a large variety of conditions. To that end, we offer the following surgical procedures.

Arthroscopic surgery

This type of surgery is a minimally invasive method that uses a camera, tiny instruments and small incisions to treat FAI and other hip complications. Arthroscopy allows surgeons to repair damaged cartilage and restore function to the systems that support your bones and joints.

Additionally, arthroscopic surgery is how we accomplish hip replacement surgery and repair for hip labral tears. This and other minimally invasive methods benefit you by resulting in minimal scarring and fast recovery.

Bone grafts

If you have a damaged or diseased bone, our surgeons can take healthy bone from a different part of your body and insert it into the damaged site to encourage healing. A bone graft allows cells in the old bone to join with the cells in the new bone, with one goal of restoring overall function. We can use bone grafting on almost any bone in the body, making it a useful tool for limb preservation.

In some rare cases of osteonecrosis, meaning fractures that have failed to join through other means, you might need a vascularized bone graft to increase blood flow.

Surgical oncology

If you have bone cancer in your extremities, it can cause tumors that need surgical intervention to avoid amputation. After removing the tumors, we can reconstruct your limb and restore as much of its function as possible.

To begin this process, chemotherapy, radiation therapy or other drug therapy are typically used for a period of time to shrink the tumor and kill its cells. After the tumor has shrunk, we'll remove it, along with any surrounding damaged or diseased tissues.

Critical limb ischemia (CLI)

An urgent condition, critical limb ischemia occurs if you get extensive blockages in the arteries of your lower extremities. It typically affects your legs.

Our cardiologists specialize in several endovascular intervention procedures. During this nonsurgical treatment, we open your blood vessels to avoid amputation and ease your symptoms.

In some cases, surgery is necessary. We perform the following surgeries for CLI:

• Carotid endarterectomy
• Coronary artery bypass grafting (CABG)
• Leg artery bypass

Amputation

While much of our work focuses on saving your limb, you might need our expertise to get an amputation. If your limb issue becomes persistent and recurring, the affected limb might be holding you back from returning to a higher level of activity that could be possible after getting it amputated.

We begin by determining if the amputation is necessary. Our care team meets with you to assess you medically and, equally important, to learn about your goals, needs and desires. We see you as a person, first and foremost, and prioritize your physical, mental and emotional health. If amputation is the right choice, our team offers Ertl-type amputations as well as a transition to Ertl-type amputations.

Once the surgery is planned, our work has just begun. We provide comprehensive care that includes performing the surgical procedure and then working with you on:

• Choosing a prosthetics or orthotics
• Finding a support group
• Getting targeted muscle reinnervation and residual limb lengthening if applicable

The relationships we form with you often go on for many years and we feel honored that you've made us a part of your journey.