Orthopedic Oncology

The Montefiore Approach

The Orthopedic Oncology program at Montefiore is one the most comprehensive of its kind in the region. Together, with the Montefiore Einstein Center for Cancer Care and its research partner, the Albert Einstein Cancer Center, our knowledge and expertise ensures the highest quality of care for even the most complicated cases.

Our team of specialists is dedicated to the diagnosis and management of tumors, both benign and malignant, primary and secondary. Through the coordinated efforts of our medical and surgical subspecialists, we provide thorough multidisciplinary care for all of our patients.

As an academic medical center, we are constantly striving for innovations in tumor treatment. Our participation in basic, translational, and clinical research allows us to explore exciting new methods for the advancement of care within our own health system and beyond.

  • Our Patient-Centered Care

    The experience of our patients and their loved ones—not simply their ailments—demands our full attention. Your dedicated care team will be there to discuss your condition, answer questions, assess treatment options, and develop a treatment strategy that is best for you.

  • Our Expertise

    Bone and soft-tissue tumors present unique challenges. At Montefiore, we believe that optimal outcomes are the product of thorough evaluations, accurate diagnoses, and intelligent patient-specific treatment plans developed through years of clinical experience.

    Working as a team, we create comprehensive care plans for every patient. A collaborative strategy helps to remove traditional boundaries between specialists and minimizes the number of patient visits. Our multidisciplinary approach ensures clear communication between clinicians and allows for the simplified coordination of diagnostic studies, treatments, and follow-up visits.

    Every week, specialists meet to discuss diagnoses and treatment plans for our patients. Imaging studies, test results, biopsy findings, and relevant patient information are all reviewed and taken into consideration. From there, individualized treatment strategies are designed using evidence-based medicine, national guidelines, ongoing clinical trials, and the group’s combined clinical expertise.

  • Our Dedication to Research

    Our status as an academic medical center puts us at the forefront of our field. Together with our Albert Einstein College of Medicine, one of the highest NIH-funded institutions in the country, we work towards excellence in orthopedic study and care. We continually participate in advancing cancer treatment through translational and clinical research. By participating in national and international clinical trials, we are able to help discover better treatment options for our patients. We routinely present our research findings in national and international conferences and publish our study results in numerous peer-reviewed publications.

Conditions We Treat

Montefiore treats a vast spectrum of conditions, a selection of which you will find listed below. In addition to these, we have experience treating many other conditions. Please contact us today to schedule a consultation so that we can review and discuss your specific healthcare needs.

Some Common Conditions

  • Adamantinoma
  • Chordoma
  • Chondrosarcoma
  • Angiosarcoma of bone
  • Hemangioendothelioma
  • Ewing's sarcoma
  • Epithelioid sarcoma
  • Dermatofibrosarcoma protuberans
  • Angiosarcoma of soft tissues
  • Synovial sarcoma
  • Rhabdomyosarcoma
  • Malignant tumors of peripheral nerves (MPNST)
  • Liposarcoma
  • Leiomyosarcoma
  • Fibrosarcoma
  • Undifferentiated Pleomorphic Sarcoma

Our Treatments

Treatment plans are designed to maximize our patients’ oncologic and functional outcomes, returning them to health as quickly as possible. Whenever we can, we employ the use of non-operative treatments. When surgery is needed, we always consider the most conservative approach appropriate. For those seeking further information, we have included a few examples of common procedures that we perform at Montefiore.

Highlighted Treatments

  • Limb-Salvage Surgery

    In many instances, it is feasible to remove an extremity tumor using limb-salvage surgery, wherein the tumor is removed without the need for amputation, sparing the affected arm or leg. The main purpose of limb-salvage surgery is to properly remove the tumor while maintaining, whenever possible, important anatomic structures like nerves and blood vessels. This highly specialized surgical approach can be utilized in most cases of bone and soft-tissue tumors.

    After successfully removing the tumor, our goal is to reconstruct the limb and restore limb function to the greatest extent possible. This is often achieved by utilizing metallic internal prostheses, allograft bone (cadaveric), or allograft-prosthetic composites. Soft tissue reconstruction may involve the use of skin grafts, free vascularized muscle flaps, or composite flaps. In rare cases, blood vessels and nerves that are involved in the tumor must be removed and subsequently reconstructed.

    Limb-salvage surgery is frequently combined with other treatments like radiation therapy, systemic chemotherapy, physical therapy, palliative care, and/or pain management. Treatment plans ultimately depend on many patient-specific and tumor-specific factors. Every patient’s care plan is customized, with the goal of maximizing an individual’s oncologic and functional outcomes.

  • Growing Implants

    For children, removing a tumor in or around a major joint can be particularly challenging, as it frequently requires removing one or more growth plates. As a result, the child’s growth is impacted, with the involved limb expected to grow less than the opposite side. In the past, a child would undergo multiple major surgeries to adjust the implant as he or she continued to grow. Today, it is possible to use a growing implant, which extends or lengthens over time. This permits a child’s limb to keep up with the opposite side, maintaining anatomic symmetry. This provides obvious benefits in functionality, comfort, and aesthetics for the patient.

    Growing implants can be minimally invasive or non-invasive. A minimally invasive implant requires a minor surgical procedure for each lengthening, during which one or two small incisions are needed. Surgeons introduce small surgical screwdrivers through the incisions. By rotating these drivers, the implant lengthens. After an acceptable length has been achieved, the incisions are closed and the patient is awakened from anesthesia. The patient can immediately walk on the implant and often can go home the same day with minimal discomfort, which usually resolves in one to two days.

    A non-invasive growing implant does not require additional surgery or anesthesia. Instead, these implants are lengthened internally using a magnet to rotate a gearbox inside the implant. The patient can remain awake during this process with minimal to no discomfort. The lengthening happens in-office and takes roughly 15 to 20 minutes. The patient can walk on the implant immediately and go home directly following the lengthening.

    Growing implants represent patient-specific and cutting-edge orthopedic implant technology. These implants are reserved for a small group of pediatric patients with unique reconstructive challenges owing to their continued growth potentials. This individualized reconstructive method avoids the need for amputation or other more ablative surgeries, allowing the restoration of routine function in a majority of patients.

  • Custom Joint Replacement

    Custom joint replacement implants are used to rebuild or reconstruct a patient’s joint following surgical resection of a tumor in or adjacent to a major joint. While standard joint replacement implants can often be employed successfully, in some instances custom-designed implants may prove to be a better solution. Tumor size, tumor location, remaining bone stock, or other patient-specific considerations determine what implant is appropriate.

    Each custom implant is patient-specific, designed to match a patient’s size, anatomy, and reconstructive needs. Implants are designed and manufactured by select orthopedic implant companies using cutting-edge technology. During the design process, surgeons work closely with engineers and other specialists to ensure the implant fits the anticipated surgical plan and meets all related engineering and manufacturing standards.

    Custom implants are reserved for a small group of patients with unique surgical and reconstructive challenges. This individualized reconstructive method avoids the need for amputation, allowing the restoration of routine function in a majority of patients.

  • Navigation-Guided Surgery

    Navigation-guided surgery, also referred to as image-guided or computer-assisted surgery, uses imaging modalities, such as a CT scan, to increase the accuracy of a procedure. This technology tracks the position and movements of surgical instruments, linking them to an imaging study in real time. This allows the surgeon to make very small, very specific corrections, thereby greatly improving surgical accuracy.

    While not necessary in every procedure, navigation-guided surgery serves as a valuable surgical tool in select patients with tumors located in the pelvis or spine. This treatment can maximize surgical accuracy, aid reconstructive fit or fixation, and improve patient outcomes.

  • Allograft Bone Reconstruction

    Allograft bone is used to rebuild or reconstruct a patient’s limb following surgical removal of a tumor. While joint replacement surgery can often be used successfully, there are instances when using cadaveric structural bone is a feasible alternative.

    As an example, some tumors involve the central portion of a long bone, which does not require joint replacement reconstruction. In these cases, reconstruction can be achieved with an intercalary allograft bone. Once healed, this can offer excellent functional outcomes.

    Carefully screened allograft bones are selected from accredited and reputable bone banks. The bone is sized to closely match a patient’s anatomy and address their individual needs as best as possible. This treatment is an excellent example of personalized surgical planning, tailored to a patient and their particular reconstructive needs.