Osteosarcoma and Rotationplasty: Mason’s Story

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When 8-year-old Mason complained about on-and-off pain in his left leg, his parents believed it was just growing pains like his older siblings experienced. But just to be safe, his mom brought Mason to urgent care for an X-ray. That’s when they learned Mason had something “consistent with osteosarcoma.”

“Bone cancer?!? We were stunned,” says Melissa, Mason’s mom. “We took him to Children’s Hospital of Philadelphia (CHOP) right away.”

Cancer found in leg and lungs

Mason playing outside in leaves At CHOP’s Philadelphia Hospital, Mason and his parents were greeted in the Emergency Department by a team of specialists from orthopaedics, oncology and emergency services. They quickly sprang into action: gathering details about Mason’s health, performing additional tests and planning next steps.

Testing confirmed Mason had osteosarcoma – the most common type of malignant (cancerous) bone tumor in children – in his thigh bone (femur). It also revealed that Mason had a concerning spot in his lungs and would need treatment to keep it from spreading further.

Two days later, surgeons removed the tumor from Mason’s lungs, and he began chemotherapy immediately afterwards. Mason was able to continue treatment while doctors and his family discussed the best approach to the large tumor in his thigh. Oncology Nurse Navigator Shannon Froio, RN, supported Mason and his family throughout his treatment.

For the next three months, Mason received nearly weekly chemotherapy at CHOP. Each time, he was hospitalized for four or five days while his body adapted to the medication. His mom stayed with him, and a tutor came to their home each weekend to support Mason’s continued education.

Surgical options for a bone tumor in the leg

While the chemotherapy helped destroy any remaining cancer cells in Mason’s lungs, the tumor in his thigh would need to be surgically removed. This would require close collaboration between CHOP’s orthopaedics and oncology teams, both #1 ranked pediatric specialty programs in the nation by U.S. News & World Report.

Orthopaedic surgeon Alexandre Arkader, MD, oncologist Rochelle Bagatell, MD, and oncology fellow Christina Turn, MD, met with the family multiple times to discuss the potential treatment options, including:

  • Removing the tumor and replacing the diseased bone with a metal rod or a cadaver bone
  • Amputation of the limb above the knee and replacement with a two-joint (knee and ankle) prosthetic
  • A Van Nes rotationplasty, a very rare and technically demanding surgery in which a functional amputation is performed when the ankle joint is rotated 180 degrees and reattached to replace the knee joint. A prosthetic would then only be needed to replace the lower leg, ankle and foot.

After talking with CHOP doctors, the family decided rotationplasty offered Mason the best opportunity for a functional leg, and the lowest chance of the cancer recurring.

Mason says the rotationplasty “sounded cool” and was thrilled to learn that once he was fitted with a prosthetic and learned how to use it properly, he’d likely be able to run again. He wanted to continue his active lifestyle – including on the basketball court, where he’d earned the nickname “Mason buckets” – and hoped to become a professional athlete.

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Recovery after rotationplasty: Adjusting to a new normal

Mason and CHOP physician In May 2021, Dr. Arkader successfully performed the complex operation on Mason, carefully sparing the nerves and blood vessels with realignment of the lower extremity muscles and fixation of the rotated segment.

When Mason woke up from after surgery, child life specialist Michelle Preston, CCLS, was with him at the bedside and helped relieve his intense anxiety when he saw his new leg for the first time.

“She listened to him, reassured him and made sure he understood how the surgery he chose would help him achieve his goals,” Melissa says. “She made everything better for him. She was amazing.”

Mason went home after a few days of recovery at the hospital, then resumed his chemotherapy regime: Into the hospital on Monday, back home on Thursday or Friday, then home for the weekend. Fitting for his prosthetic would come later, after his wound had healed.

Real-world advice from the pizza guy

After surgery, Mason still had lingering questions about how his changed leg would affect his day-to-day life. He found real-world answers from an unlikely source: the family’s pizza delivery guy.

“We ordered pizza one night and Josh, the pizza delivery guy, had had rotationplasty,” Melissa says. “I asked him to come and talk to my son. He did more than that. He sat with Mason, took his prosthetic off and answered all of Mason’s questions about how it works, how he adapted and what he can do now. It was so kind of him and relieved a lot of Mason’s anxiety about what his life would be like when he got his own prosthetic.”

That conversation reinvigorated Mason and encouraged him to find new ways to continue doing the things he loved. “He has a wheelchair and walker to help him get around, but he also hops or scoots depending on what he’s trying to do,” Melissa says.

Over the summer, Mason rode an electric bike, skateboarded with his walker, went on roller coaster rides, and has continued to play basketball.

“He just keeps pushing himself,” his mom says. “Not one time in eight months has he complained about anything. He knows what’s happening and just makes the best of it.”

Full speed ahead and learning to use his new prosthetic

Now in third grade, Mason has much to look forward to: His last chemotherapy session, learning how to use his new prosthetic, returning to school full-time, meeting new friends and celebrating the winter holidays with family and friends.

“We want to focus on helping him walk again,” Melissa says. “Mason’s osteosarcoma diagnosis was life-changing for him and our family.

“The team at CHOP has been amazing through it all. They really took an interest in Mason, and it’s made a profound difference on his attitude and health. We can’t thank them enough.”

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