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Endoprosthetic replacement after bone tumour removal | CION Cancer Clinics
An endoprosthesis is a metal implant that replaces the length of bone, and usually the joint, removed with a bone tumour. It is fitted in the same operation, so you wake with the limb in one piece and a joint that moves. This page explains where it is used, what the months afterwards look like, how implants can fail, and what to ask your surgeon before agreeing. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is an endoprosthesis, and why is it used after a bone tumour?
- The places an endoprosthesis is most often fitted
- From the operation to walking again
- Words you will see, in plain language
- Four things families tell us, and what is actually true
- What this page cannot tell you
- Common questions about endoprosthetic replacement
The short answer
What is an endoprosthesis, and why is it used after a bone tumour?
An endoprosthesis is a metal implant that replaces the section of bone, and usually the joint, removed with a tumour. It is fitted in the same operation, so you wake with the limb in one piece and a joint that can move. It is the most common way of saving a limb after a bone tumour is taken out around the knee, hip or shoulder.
What it is made of and how it holds
The implant is a shaft of titanium or a cobalt alloy with a hinged or ball joint at one end. A long stem is fixed into the remaining bone, usually with bone cement. Muscles are then stitched around it so the joint can move and the skin has padding over the metal.
How it differs from a joint replacement for arthritis
A knee replacement for arthritis swaps only the worn joint surface. An endoprosthesis replaces a long length of bone as well, because the tumour and its margin, the rim of healthy tissue around it, have gone.
Who it does not suit
It is not offered when the tumour has grown into the main nerve or vessels, when the skin over the site has broken down or is infected, or when general health makes a long operation unsafe. In a young child, a growing implant or a different operation is considered instead.
Not every centre uses every implant type. Ask your surgeon which implant they are proposing, and why that one.Where it goes
The places an endoprosthesis is most often fitted
Bone tumours in young people cluster around the knee, so that is where most of these implants are used.
Around the knee
The lower thigh bone or the upper shin is replaced together with a hinged knee. Walking is usually good; running and jumping are limited to protect the implant.
Often needs
- A brace in the early weeks
- Long physiotherapy for the thigh muscle
The top of the thigh bone
The upper thigh bone and the ball of the hip are replaced. Walking recovers well for most people, though the hip can be less stable than your own and needs care with certain movements.
The top of the arm bone
The upper arm bone and the ball of the shoulder are replaced. The hand and elbow usually work well. Lifting the arm above the shoulder is often limited, because the muscles that do that had to be removed.
The pelvis
An implant can replace part of the pelvis after a tumour there. It is an uncommon, complex reconstruction with a long recovery and a higher chance of problems than the others.
Ask how many of these your centre does each year.Not sure whether this applies to you?
Ask an oncologistThe pathway
From the operation to walking again
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The operation
A long procedure under general anaesthetic. The tumour is removed with its margin, the implant is fitted and the muscles are rebuilt around it. The removed bone goes to the pathologist to check the margin.
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The first days
You have a drain, a dressing and a pain plan, often with a nerve block. Physiotherapy starts early, moving the joint and getting you upright with support, usually before you feel ready.
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The first weeks
How much weight you may put through the limb depends on where the implant is and how it was fixed. Many people walk with crutches and a brace. Wound care is the priority, because infection is the main risk.
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The first months
The muscles around the implant are rebuilt through exercise. This is slow, and it is where the eventual result is decided. Chemotherapy, if it is part of the plan, usually restarts once the wound has healed.
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The years after
Follow-up scans check both the cancer and the implant. Loosening, wear and infection can appear years later, so the follow-up continues long after the cancer visits become less frequent.
On your operation note
Words you will see, in plain language
- Megaprosthesis
- Another name for an endoprosthesis that replaces a large length of bone. The two words are used interchangeably.
- Stem
- The long metal rod that anchors the implant inside the remaining bone. Its fixing, cemented or uncemented, is one of the things that affects how long the implant lasts.
- Hinged knee
- A knee joint that is mechanically linked, because the ligaments that normally hold a knee together were removed with the tumour.
- Extensor mechanism
- The thigh muscle and tendon that straighten the knee. Whether it could be kept or had to be rebuilt largely decides how well you will walk.
- Revision
- A further operation to exchange part or all of the implant. Over a lifetime this is common, and it is planned for rather than feared.
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One thing that cannot wait
After you go home, a wound that becomes red, hot or swollen, that leaks fluid, or a fever with pain around the implant needs the surgical team the same day. Infection around a metal implant does not settle on its own, and treating it early can save the implant. Call the number you were given, or go to an emergency department and say you have a tumour implant. Do not start antibiotics from a pharmacy first; that hides the infection without treating it.
Commonly believed
Four things families tell us, and what is actually true
"Once the implant is in, the cancer cannot come back in that leg."
The implant replaces bone; it does not prevent recurrence, the cancer returning in the same area. That risk depends on the margin and the tumour type. Follow-up scans look at the tissue around the implant for exactly this reason.
"The implant is for life."
Many last for years, but they are mechanical parts under daily load. Loosening, wear and infection can each need a further operation. It is better planned for than a surprise.
"With metal inside, an MRI or radiotherapy is no longer possible."
Modern implants are safe in an MRI scanner, though they blur the picture nearby, so other scans are sometimes used. If radiotherapy is needed, the planning team allows for the metal. Tell every doctor that you have an implant.
"Rest is safest. Physiotherapy might damage it."
The opposite. The implant is fixed; it is the muscle around it that decides how well you walk, and muscle only rebuilds through use. Skipping physiotherapy is the commonest reason a good operation gives a poor result.
Being straight with you
What this page cannot tell you
It cannot tell you whether an endoprosthesis is the right operation for the person you are worried about. That depends on the MRI, the tumour type, how it answered chemotherapy and general health. Nor can it say how well the limb will work, because that depends on which muscles could be kept.
It cannot promise the implant will last
Implants fail in known ways, and some people need further surgery within a few years while others go far longer. Ask your surgeon for their own experience with your implant and site.
What to ask your surgeon
- Which implant, and why that one for this tumour?
- Which muscles will have to be removed, and what will that limit?
- How much weight can I put through the leg, and from when?
- What are the signs of infection, and who do I call?
- How often will the implant itself be checked?
Questions we are asked
Common questions about endoprosthetic replacement
Will I be able to walk normally with an implant at the knee?
Most people walk without a stick on flat ground and manage stairs. A slight limp is common, and running, jumping and heavy lifting are usually advised against to protect the implant. How close to normal you get depends mostly on the thigh muscle and your physiotherapy.
Is the operation done before or after chemotherapy?
For most bone cancers, in the middle. The first cycles of chemotherapy come before the operation, the implant is fitted, and chemotherapy restarts once the wound has healed. Your medical and surgical oncologists set that timing together.
Will the metal set off airport security?
Often, yes. It is a large piece of metal. Carry your discharge summary or an implant card when you travel and tell the security staff before the scanner. It is routine for them and means only a short extra check.
Can an implant be used in a child who is still growing?
Yes, but a different kind. A growing implant can be lengthened in small steps as the child grows, so the operated leg keeps pace with the other. It carries more procedures over childhood and usually a further operation at the end of growth.
How do I know if the implant has become infected?
Redness, heat or swelling around the scar, fluid leaking from the wound, new pain in the limb, or a fever. Any of these after going home needs the surgical team the same day. Infection caught early can often be treated while keeping the implant; caught late, it may not be.
What happens if the cancer comes back near the implant?
The team rescans and, if it is confirmed, discusses removing the recurrence with a clear margin. Sometimes that is possible while keeping the implant; sometimes it means a larger operation, including amputation. This is why follow-up scans continue for years.
Can I kneel, squat or sit cross-legged on the floor?
With a hinged knee implant, deep squatting and sitting cross-legged are usually limited or advised against, which matters for prayer, eating and toilets at home. Ask early, because small changes at home, such as a chair or a raised toilet seat, make daily life much easier.
Is the implant covered by Aarogyasri or insurance?
The operation is usually covered within scheme limits under Aarogyasri, CGHS, ECHS and EHS, and most cashless insurers are empanelled. The implant itself may be covered in part, in full, or separately, depending on the scheme and the implant. Call the helpline with your card and reports and we will check before you travel.
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Dr. C. Raghavendra Reddy
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MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
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Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Sources
- Cancer Research UK — Treatment for bone cancer
- American Cancer Society — Surgery for osteosarcoma
- NHS — Bone cancer: treatment
- National Cancer Institute — Osteosarcoma and Undifferentiated Pleomorphic Sarcoma of Bone Treatment (PDQ)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
How Long Does an Endoprosthesis Last?The ways implants fail and what a revision involvesGrowing Prostheses for ChildrenThe lengthening implant used when a child is still growingAllograft and Biological ReconstructionThe alternative that rebuilds with bone rather than metalLimb Salvage or Amputation: How the Choice Is MadeThe decision that comes before any reconstructionComplications and Red FlagsWhat to watch for after any cancer operation
Talk to us
Been offered an implant after a bone tumour?
Send us the MRI and biopsy reports, or call the helpline. A surgical oncologist will explain what the reconstruction involves and what it would mean for walking or using the arm. One helpline serves every CION centre.