Hip Fracture Leads to Tumor Discovery

Deborah Bunner had no plans for a hip replacement. Believing she suffered from arthritis, she  endured significant pain in her hip over the past four years. “It was excruciating. I know now  that I was foolish for not going to a specialist sooner.”

Deb Bunner sitting on outside couch with 3 french bulldogs
Deborah Bunner and her three four-legged friends.

Bunner lives in West Knoxville with her husband and three French bulldogs. Last autumn,  the retired kindergarten teacher consulted her physician about her persistent hip pain, and she had an MRI. She received a phone call that same afternoon. The MRI had
revealed a large mass in her uterus. I would recognize Bunner underwent a hysterectomy,  or removal of the uterus and ovaries, in December 2019. The surgery included removal of the  tumor and she healed nicely. She thought that perhaps it was the mass in her uterus that had  caused her hip pain, and now it would cease. She was wrong.

Divine Intervention

A short three months later, the hip pain had progressed. Bunner walked with two canes because  her pain was so debilitating. While she was hanging clothes in her closet, one of the canes slipped
and she took a tumble onto the hardwood floor, causing her left hip to fracture on impact. An  ambulance brought her to Parkwest Medical Center.

Dr. Hamilton headshot
D. Hunter Hamilton, MD

“That is when I met Dr. Hamilton — he was the surgeon on call that day,” remembers  Bunner. “He looked at my scans and told me we had an issue.” The fracture revealed a  sarcoma tumor in her hip. “Had I not fallen and fractured my hip, we would not have found it.” She  recalls, amazed, “The tumor in my hip was not visible in scans before because it was inside,  sitting there like an egg.”

D. Hunter Hamilton, MD, is an orthopedic surgeon at Parkwest Medical Center who is  fellowship-trained in hip and knee replacement. “When you get mechanical joint pain, or pain
with daily activity, it often means you have degenerative changes within the joint, like  arthritis,” says Dr. Hamilton. “In this case, it was the tumor, which had spread from the  uterus to the inside of the hip and was eroding the bone, making the bone weak and  causing pain.”

Bunner says she gets chills thinking back on the divine intervention that occurred that day. “I am just so  thankful and blessed.”

Hip Reconstruction

Bunner says she communed with God for the hours leading up to surgery. “I had no fear; I  knew everything was going to be fine.”

“On top of that,” she says, “I had this endearing, comforting man as my doctor. He  went above and beyond for me. When I told him about my faith, he offered to pray with  me. He was confident he would get me back on my treadmill. Now I’m on it every day.”

Dr. Hamilton is accustomed to performing both hip and knee replacements In Bunner’s  case, he performed a cemented left hip hemiarthroplasty (“hemi” meaning half and “arthroplasty” meaning joint replacement). Dr. Hamilton removed the part of the tumor he could see and any weakened  bone surrounding it. He reconstructed her hip with a cemented partial replacement. He chose a  cemented implant over an implant that is “wedged” into place that requires bone to  ingrow for stability because the cement will provide implant stability in case she requires  future radiation to the hip that could prevent bony ingrowth resulting in a loose stem. He chose a  partial hip replacement instead of a total hip replacement in the hope of preventing spread  of the tumor to the pelvic side of the hip joint.

He reports, “She had a leiomyosarcoma, a tumor that was identical to the one removed from her uterus. It has spread  to her hip.” Dr. Hamilton notes that had the tumor not been removed, there was a risk for  soft tissue and muscle tissue cells to metastasize to other places in the body, including  spreading to the lungs.

”Beyond Thrilled”

“When Dr. Hamilton informed me there was a cancerous tumor inside my hip, I felt relief. I  thought, ‘Thank goodness, now we know what’s wrong!’

“A few hours after surgery, a nurse helped me stand. I was beyond thrilled because the  pain was just… gone. That horrible pain I had endured for years had vanished. I was  beyond thrilled.”

Following surgery, Bunner’s CT scan and PET scan were clear, indicating no sign of cancer.

“It’s a privilege and it’s gratifying,” says Dr. Hamilton. “As orthopedic surgeons, to  restore function, often quite rapidly, we get to see how much life has improved for a patient, and how differently people carry themselves.”

Dr. Hamilton encourages people to not be afraid of surgery because Parkwest has specialists in so many areas. “Overall, I’d say if joint pain is affecting your quality of life and keeping  you from being able to do what you enjoy doing, we have excellent solutions for that.”

At Parkwest

Besides excellent medical care, Bunner describes her treatment at Parkwest as  “fabulous.” “I can’t say enough good things about Parkwest. I have just had the most  heartwarming experiences, from my medical care to each person who treated me.”

To anyone who has a nagging pain but is hesitant to get it checked out, Bunner says, “go.”  She encourages adults to consult their regular physician and if needed, ask for a referral to an
orthopedic doctor. “Don’t stop asking questions,” she urges. Bunner describes her journey as receiving a new life. “I feel as though I have been given a  ticket to keep riding this train, to see how far I can go. I feel great.”

Contact the Parkwest Joint Replacement Center today to be connected with the joint center coordinator or  to be referred to a physician who performs joint replacement surgeries at Parkwest. For more
in- formation about the pro- gram, call 865-374-PARK or visit TreatedWell.com

What is Hip Replacement Surgery?

Hip replacement (total hip arthroplasty) is surgery to replace a worn out or damaged hip joint. The surgeon replaces the old joint with an  artificial joint (prosthesis). This surgery may be a choice after a hip fracture or for severe  pain because of arthritis.

diagrame of hip joint with and without arthritis

Various types of arthritis may affect the hip joint:

  •  Osteoarthritis. This is a degenerative joint disease that affects mostly middle- aged and older adults. It may cause the breakdown of joint cartilage and adjacent bone in the hips.
  • Rheumatoid arthritis. This type of arthritis causes inflammation of the synovial lining of the joint. It causes extra synovial fluid and may lead to severe pain and stiffness.
  • Traumatic arthritis. This arthritis is caused by an injury. It may also damage the hip cartilage.

The goal of hip replacement surgery is to replace the parts of the hip joint that have been  damaged. It also helps relieve hip pain that can’t be controlled by other treatments.

A traditional hip replacement involves an incision several inches long over the hip joint. A newer  approach uses one or two smaller incisions to do the surgery. This is called minimally invasive hip
replacement. The minimally invasive procedure is not suited for all people who need  hip replacement. Your healthcare provider will recommend the best procedure for you.

What is Recovery Like?

For a typical hip replacement, patients start physical therapy immediately and continue for  six to 10 weeks. They are instructed post-operation to bear weight as much as they can  tolerate. Patients generally use a walker for one to two weeks, followed by walking with a cane,  and report overall pain relief to be significant.

What is Soft Tissue Sarcoma?

Sarcoma is a type of cancer that starts in the body’s connective tissues. These are tissues that  support or protect other parts of the body. Soft tissue sarcomas can start in muscles, tendons,
blood vessels, fat, nerves, and deep skin tissues. These cancers can start in almost any part of  the body. (Although body parts such as the lungs, kidneys, and liver are soft, they have specific
functions. Because they do very specific jobs, they aren’t considered soft tissues. Most cancers  that start in these organs are not soft tissue sarcomas.)

What are the types of soft tissue sarcomas? These are dozens of different types of soft tissue  sarcomas. But many of these are rare.

Here are some of the more common types of soft tissue sarcomas:

  • Angiosarcomas. These cancers start in blood or lymph vessels.
  • Fibrosarcomas. These cancers start in fibrous tissues, usually in the arms, legs, chest, or back.
  • Gastrointestinal stromal tumors (GISTs). These cancers can occur anywhere along the digestive  tract. They are treated differ- ently from most other types of sarcomas. This is because they often respond to treatment with targeted therapy medicines.
  • Leiomyosarcomas. The cells in these cancers are related to smooth muscle cells. These cancers are often found in the abdo- men or uterus. But they can also start in other parts of the body. These include the leg or arm muscles.
  • Liposarcomas. These cancers start in fat cells. Although they can be found anywhere in the body, they often start in the abdomen or thighs.
  • Malignant peripheral nerve sheath tumors. These cancers include neurofibrosarcomas and malignant schwannomas. They are cancers of the cells that wrap around nerves. These tumors are rare. They may be seen in people with some inherited syndromes, such as neurofibromatosis.
  • Synovial sarcomas. These are cancers of the synovial tissues that surround joints. These cancers most often occur in the hip, knee, ankle, or shoulder
  • Undifferentiated pleomorphic sarcomas. These cancers used to be called malignant fibrous histiocytomas. They are most com- mon in the arms or legs. But they can also start in other parts of your body.