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Expandable High-Tech Bone Implants 'Grow' As Children Do

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Posted: 4/2/2007

COLUMBUS, Ohio – With cancer attacking the upper arm bone of 5-year-old Elizabeth Link, the treatment options were limited: Either amputate the arm or implant an experimental expandable surgical device that could “grow” along with the little girl.

Her doctor and parents chose the experimental implant.

Elizabeth is one of the youngest patients nationwide to undergo the rare procedure, says Dr. Joel Mayerson, director of the division of musculoskeletal oncology in the department of orthopedic surgery at Ohio State University Medical Center.

Mayerson, also a member of the Ohio State University Comprehensive Cancer Center, is among 65 orthopedic oncologists in the United States who have implanted about 265 of the devices.

“These devices are very experimental,” says Mayerson, an attending physician at Ohio State’s James Cancer Hospital and Solove Research Institute who has implanted the device in eight young patients during the past five years. “The problem with such a young child is that she would not have any way to grow with the normal reconstructive methods we have.”

The Food and Drug Administration has not yet approved the device, so Mayerson had to seek “compassionate-use” approval from the FDA before proceeding with the operation, he says.

In addition, Elizabeth needed a bone transplant because Mayerson had to remove most of the humerus – the upper arm bone – to treat the cancer. Donated bone was needed to fill the gap between what remained of Elizabeth’s humerus and the implant.

A nationwide search last fall finally identified a matched donor, a 5-year-old girl in Illinois who had died. The surgery took place in early October at Columbus Children’s Hospital, where Mayerson holds a joint appointment.

“This is a wonderful combination of modern technology and modern bone banking,” says Mayerson, who also co-directs the bone sarcoma clinic at Columbus Children’s Hospital.

“Elizabeth Link is a living example of the importance of organ donation. Most people don’t think of bones as organs they can donate,” says Mayerson. “They hear about heart, lung and kidneys, but we also need donated bones for reconstructive work, and it’s a way to make the best of a tragic situation sometimes.”

During the surgery, Mayerson removed the osteosarcoma, an aggressive form of bone cancer, and replaced it with the donated bone and with the high-tech implant that can be expanded as the child grows.

The implant consists of a hollow titanium tube inside a plastic tube housing a compressed stainless steel spring. The device expands when warmed by heat generated by an electromagnetic field, which softens the plastic tube, allowing the device to lengthen. The procedure, performed on an outpatient basis, takes just a few minutes to complete and results in little or no pain, Mayerson says.

“This is completely noninvasive. The patient feels a little discomfort from the heat and the stretching, but otherwise they are fairly comfortable,” Mayerson says.

Elizabeth is scheduled for X-rays of both arms every six months to monitor her growth. Once her left arm is about 1 to 1.5 centimeters longer than her right arm, Mayerson will schedule her for her first lengthening procedure. When she’s about 10, Elizabeth will outgrow her expandable device and will require another surgery to implant a larger one that should take her well into her teen years, Mayerson says.

“Because of this device, Elizabeth was able to keep her arm, which will help her lead a normal, healthy life,” Mayerson says, adding that more research is needed to measure how the device performs over time.

The implant, called the Repiphysis, is manufactured by Wright Medical Technology located in Arlington, Tenn.

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Eileen Scahill
Medical Center Communications

James Cancer Hospital; OSU Medical Center