The future of metastatic bone cancer surgery: the innovations that are transforming lives, with Mr Jonathan Stevenson

Secondary bone cancer has long been one of the greatest challenges in cancer care. However, significant progress in surgical techniques and a deeper understanding of the disease are changing the landscape of treatment and patient outcomes.

One of the key figures driving these advancements is Mr Jonathan Stevenson, a consultant orthopaedic surgeon specialising in metastatic bone disease at HCA Healthcare UK The Harborne Hospital. His pioneering work is not only improving quality of life for patients but, in many cases, significantly extending survival. 

We spoke to him about his novel approach to metastatic bone cancer surgery and how innovations like 3D laser printed implants and the emergence of meta-metals are quite literally shaping the future for patients. 

Why did you choose to specialise in metastatic bone disease?

“It’s a fascinating, fast evolving area of medicine, but what truly inspires me is the complexity of the condition and the patients themselves. Because it’s such a niche surgical area, it can be a long road for patients to get the answers they need. As a specialist, being able to give people the clarity and definitive treatment plan they’ve been waiting for is incredibly rewarding. I see these patients for many years, as they regain their mobility and live their lives, so the relationship that you build up with them is very special. 

And unlike routine orthopaedic surgery, where you might replace a hip or a knee to improve mobility, our work goes further; we are trying to extend the quality and quantity of patients’ lives. That dual aspect appeals to me. As an orthopaedic oncologist, I sit in a unique position at the intersection of medicine and surgery, understanding both the language of oncology and orthopaedics.” 

How important is multidisciplinary collaboration in bone metastases? 

“The multidisciplinary team plays a critical role. We work in very close collaboration with medical and clinical oncologists, radiologists and pathologists, constantly discussing cases to determine the best approach. This is complex work and there’s no one-size-fits-all formula, together we must figure out how best to approach it.”

What’s the goal of surgery in metastatic bone disease, and how do you determine which patients are suitable for surgery?

“From a surgical perspective our focus is removing all the disease and reconstructing the bone. The aim here is always to improve quality of life and extend survival. Where amputation was once common, we now prioritise skeletal integrity, preserving limb function, and importantly, overall well-being. 

This kind of surgery isn’t suitable for everyone, however. These are large, complex procedures with associated risks. If a patient is very unwell or has widespread skeletal disease, systemic therapies such as chemotherapy, immunotherapy, or radiotherapy may be more effective. But many patients present with isolated metastases, and that’s where we can make a real difference.

For example, we see a lot of renal cancer patients who haven’t responded to radiotherapy. Many of these patients have single bone lesions that we can surgically remove and replace with implants, potentially putting them into remission. I’ve seen patients return to work and regain their lives because of this approach.”

How has secondary bone cancer surgery changed?

“It’s night and day with what we’re doing here today and what’s considered standard practice. For example, at The Harborne Hospital, I specialise in en-bloc resection and limb reconstruction. En-bloc resection means that instead of removing multiple tumour deposits, we remove the entire tumour with a margin of normal tissue, ensuring no cancer cells remain. Usually, the role of orthopaedic surgeons would have been to stabilise the bone, but now we’re actually removing tumours.

Many patients come to me after receiving conventional surgery elsewhere, such as a pin or plate for a pathological fracture where the metalwork is placed inside the tumour. The issue is that nearly half of these fractures never heal properly, or the metalwork fails or the tumour gets larger, leading to ongoing pain, reduced mobility, and, in some extreme cases even amputation. 

Our approach - removing the tumour completely and reconstructing the bone - means patients can be mobile within days and walking within 12 weeks, and with no evidence of disease. For some, this has meant going from stage 4 cancer back to remission.”

How do you reconstruct the bone after removing the tumour?

“This is where it gets exciting. To reconstruct the bone we’re using completely bespoke, patient-specific implants created via a laser sintering technique, which is essentially 3D printing with titanium powder.

Before surgery we collaborate with the engineers, using CT & MRI scans of the patient’s skeleton to design implants that will fit perfectly in the place of the resected bone, like bespoke Lego pieces. These implants are printed in a single, seamless piece; not several pieces welded together. This is important because it removes the risk of mechanical failure. They also feature porous titanium surfaces, allowing the remaining bone to grow into them for a natural and secure integration, without the need for adhesives.

This technology isn’t widely available. I recently toured the USA and Canada, presenting our approach, they don’t have access to these innovations yet. We are genuinely leading the way. Being able to offer these technologies to patients is why I love what I do.”

What other innovations are shaping the future of secondary bone cancer surgery?

“Another exciting development is what’s known as the ‘ice cream cone’ prosthesis for pelvic reconstruction. This is a game-changer for patients with severe secondary pelvic cancers. These are some of the most poorly patients, usually in hospital with pelvic fractures. 

The prosthesis, which is shaped like an upside-down ice cream cone, is inserted into the pelvis to replace pelvic bone that’s been severely damaged by the tumour. We use satellite navigation techniques to position it precisely, protecting vital structures like the bowel and bladder. Once that’s inserted, from there we can build up a hip replacement and reconstruct the hip joint. This allows patients who were bed bound, in severe pain, and who would likely have been referred for palliative care, to regain their mobility. 

Beyond limb reconstruction, another innovation we’re working on is minimally invasive meta-metals. The idea of these 3D-printed, meta-metal implants is that they can be created to fit the specific shape of a tumour cavity, where the cancer has eaten into the bone and weakened it, then compressed and injected into that cavity using a cannula. Once in place they expand to their original shape – filling the cavity and securing the bone. A bit like when you get a mattress which is delivered rolled up, and once unraveled quickly expands to take its shape. And because they’re porous metals, they can integrate naturally with the bone, creating a strong and stable reconstruction. 

At The Harborne Hospital we are offering cutting-edge treatments not widely available elsewhere. Our team is pioneering advanced surgical techniques and bespoke implants that are transforming patient outcomes. With access to state-of-the-art technology and a highly specialised MDT, we are really pushing the boundaries of what’s possible in secondary bone cancer treatment.”