Dr Femino on Advances in Limb Salvage and Endoprosthetic Reconstruction in Sarcoma

"There's been a lot of progress made in preserving limbs for sarcoma... the primary thing that has been done is the development of endoprosthetic implants when we have to remove a sarcoma that involves the bone and the soft tissues."

Joseph Dominic Femino, MD, an orthopedic surgeon, as well as a clinical associate professor of orthopedic surgery (practitioner) and chief of Musculoskeletal Oncology at Keck School of Medicine of USC, discussed the current state of limb reconstruction after bone tumor resection in sarcoma and recent advances made in preserving both patient functioning and long-term quality of life.

When sarcoma involves the bone and soft tissues, it is often necessary for surgeons to remove a large segment of bone, frequently including the joint, Femino began. Although amputation was once the standard, the development of metal endoprosthetic implants now allows for effective limb salvage by replacing the missing bone and joint segments, he stated.

Femino highlighted that significant progress has been made in the design of these joints, particularly for the knee, to enhance long-term durability. Advancements also extend to the methods used to attach these endoprostheses to the remaining bone, he noted. For patients with only short segments of bone remaining, dynamic compressive ingrowth attachments can now be utilized instead of traditional, longer stems. Furthermore, Femino spotlighted ongoing development of the ELEOS Limb Salvage System, a prosthesis that features NanoCept Antibacterial Implant Technology. This specialized orthopedic coating consists of an ammonia ion bonded to the metal surface that is more than 99% bactericidal on contact with bacteria in the operating room, offering the potential to significantly reduce infection rates. The technology is being evaluated in a multicenter, national, postmarket study, which enrolled its first patient on February 12, 2026.

Beyond endoprosthetics, Femino discussed bone transport methods to address large tumor defects. This technique involves slowly transporting a remaining bone segment across the gap created by the resection to stimulate new bone formation in the defect. Although this process traditionally required an external fixator, it can now be performed entirely internally using an intermedullary nail or rod equipped with an internal motor, he shared. The motor is activated by an electromagnet held outside the body, which lengthens the rod and transports the bone segment, Femino explained. These innovative surgical developments represent a major leap forward in limb salvage, providing more durable and functional options for patients with sarcoma, he concluded.