At first, Parker Cain thought he had a knee problem. In 2019, a swollen knee sent this 20-year-old to a doctor in Asheville, who believed an infection was the culprit. The doctor performed a knee wash to clear the infection and told Parker that he’d be fine from there.
But when the swelling increased, Parker switched his care to Atrium Health and found out it wasn’t what he thought. There, scans revealed that Parker had advanced osteosarcoma (bone cancer) in his knee that had spread to his lungs. He began treatment at Atrium Health Levine Cancer Institute (LCI).
“My immediate first thought was, ‘Alright, how do we solve this? What do we do? I've always been the person who just says, ‘Don’t stop no matter what life throws at you,” Parker says. He’s a car enthusiast, and even in the hospital, he wanted to stay in the driver’s seat.
LCI’s multidisciplinary sarcoma team quickly developed a treatment plan for Parker. The team, which has cared for sarcoma patients for 29 years, includes orthopedic oncologists, medical oncologists, surgical oncologists, pathologists, radiologists and more. Parker’s plan began with chemotherapy with Michael Livingston, MD, Parker’s medical oncologist. After that, Parker would have a surgery to remove the cancer from his knee and then return for completion of his chemotherapy.
“Dr. Livingston knew from the beginning exactly what needed to be done to give me my best fighting chance,” Parker says.
Between his rounds of chemotherapy, Parker became the first patient in Charlotte to undergo a relatively rare type of limb salvage surgery for his bone cancer – one that would allow him to return to his usual active lifestyle.
Maximizing Quality of Life
Doctors try to avoid amputation and save limbs whenever possible. Colin Anderson, MD, an orthopedic surgeon at LCI, spent time talking with Parker to learn about his personality and his lifestyle to find the best surgery for him. Because Parker’s previous surgeries kept him from the typical surgery option, a knee replacement surgery, Dr. Anderson offered him a rare surgical option: a rotationplasty.
“Dr. Anderson said that a rotationplasty would give me the best quality of life, and that it’d get me back to doing the things I love the fastest, the smoothest and the easiest,” Parker says.
During a rotationplasty, a surgeon removes the segment of the knee that contains the cancer while keeping the blood vessels and nerves intact. Then, the surgeon re-attaches the lower leg – turned 180 degrees around – to the thigh. This means the foot points backwards so the ankle can function as a knee joint. A prosthesis – an artificial leg – attaches to the new joint. Metal implants help secure the bones’ location, but after recovery, the bones do all the work – not the implants. This can make a rotationplasty a longer-lasting, more durable solution than other surgical options
“Rotationplasty is not a common surgery by any means, but it really can be life-changing for the right patient,” Dr. Anderson says. “Parker likes mountain biking, he likes outdoor activities, and he wanted to get back to hiking. That's something that a rotationplasty can offer him. It’s truly a biologic reconstruction. That reconstruction can really last forever and put up with whatever the human body can do. There are people who, after a rotationplasty, are sprinting with blades, skydiving, windsurfing and mountain biking.”
The Right Surgery for the Right Patient
Typically, a rotationplasty is a good limb salvage option for younger patients whose skeletal systems haven’t yet matured. A young patient can heal more quickly and fully with a rotationplasty, without requiring follow-up surgeries that may be required with other surgical options. Even an adult like Parker, however, may have circumstances that make a rotationplasty a good option for them, too.
But this type of surgery is rare and few surgeons have experience in it. Dr. Anderson – who received training in rotationplasty during his residency and fellowship and who’s the only surgeon who’s performed a rotationplasty in Charlotte – performed two rotationplasty surgeries at Atrium Health Carolinas Medical Center within the last year.
Although rotationplasty can offer certain patients fuller functional recoveries, some people resist the surgery because they’re concerned about the appearance of the leg following the surgery, with the foot pointing backwards at the knee joint, according to Dr. Anderson. For Parker, what mattered most was returning to the activities he’s always loved to do.
Before Parker could receive the prosthetic leg, however, he had to continue chemotherapy. Parker’s chemotherapy was so successful that the team recommended an additional surgery to increase his chances of a cure. This surgery, under Jeffrey Hagan, MD, successfully removed the last bit of tumor in his lungs that remained after chemotherapy. And, to Parker’s amazement, his lung surgery was a minimally invasive procedure done with just five stitches.
“Once the surgery was done, I just wanted to get out and start living life again. I wanted to learn how to walk, I wanted to learn how to drive. Driving has always been one of my favorite hobbies. That was really one of my biggest motivators,” Parker says.
After surgery, it was time to learn to walk again Parker received his prosthetic leg and used a walker for a month for support; then, he used a cane for the following month.
“Since then, I’ve just been getting around on my own three feet,” he jokes.
Parker’s Big Plans
Today, Parker has scans every three months to make sure his cancer stays in remission. Before his next appointment, however, he’s got plans he’s far more excited about: a road trip with friends to drive up the tail of the dragon in western North Carolina, which is one of the most legendary sports car touring roads in the world.
“Dr. Anderson is an absolute genius,” Parker says. “I cannot thank him enough for truly giving me my life back. He made the absolute best of a worst-case scenario, and I will forever be grateful for how he was able to transform my life to get me back to doing all the activities I love.”
Learn more about cancer care at Levine Cancer Institute.
