First U.S. Funny Bone Transplant Saves Girl From Amputation

June17, 2011— -- Young Josalyn Kaldenberg and her bionic funny bone have everyone smiling.

This April, the Iowa 8-year-old became the first kid in the U.S. to receive an expandable humerus bone replacement -- a landmark procedure that saved her arm from amputation.

Just a few months ago, it seemed inevitable that Josalyn would lose her arm to the cancer that had invaded the bones of her upper arm, elbow, and shoulder. Thanks to the first-of-its-kind funny bone replacement, however, Josalyn is now back coloring, writing and playing the piano at her Woodward, Iowa home.

"It's just amazing what they can do now, reattaching all the tendons and blood vessels and nerves and have the arm actually work. Obviously we don't wish this would have happened, but it's neat to see what can come about," says Josalyn's mother, Heidi Kaldenberg.

"I like my new arm a lot," says Josalyn, who is fiercely proud of the 12 inch scar that now graces her upper arm.

The only downside, the family jokes, is that Josalyn has to get patted down at the airport as her bionic bone sets off the metal detectors.

Josalyn's new funny bone has prompted plenty of jokes, but the laughter comes more from relief than the quality of the punch line. The six months before the surgery was a scary time for Josalyn and her parents and they were days away from having to amputate the arm at the shoulder.

"We always knew amputation was a possibility, but it was still a shock when the doctors told us that they couldn't save her arm," Heidi Kaldenberg said. "I never wanted to give up hope [that we could save her arm]"

The home schooled third grader was diagnosed with osteosarcoma in November, a rare bone cancer that affects only a few hundred kids each year.

The First U.S. Expandable Funny Bone Replacement

The cancerous tumor takes over the long bones of the arms or legs, destroying the bone tissue and spreading throughout the body. Decades ago, the only treatment was swift amputation of the limb, but even then the prognosis was poor. With a combination of chemotherapy and artificial or cadaver bone transplant, saving the limbs later became possible, but it was rare in children, whose bones are still growing.

"It used to be that you could only do a salvage procedure on a child that was fully grown because when you replace it, you won't get growth," says Dr. Eugenie Kleinerman, professor and head of the division of pediatrics at MD Anderson Cancer Center. "Now we have expandable prostheses," she says.

Josalyn was only four days away from having her right arm amputated when her mother reached out to Moffitt Cancer Center in Tampa, Fla., one of the few centers in the U.S. that specializes in prosthetic bone surgery.

An adjustable arm bone prosthetic had never been placed in a child in the U.S. and the family's insurance wouldn't cover the procedure, but "everyone pitched in" to make the procedure possible for Josalyn, says the girl's surgeon, Dr. G. Douglas Letson, chairman of the Sarcoma Program at Moffitt Cancer Center. This X-ray shows the prosthesis now that it's in Josalyn Kaldenberg's arm.

Josalyn's osteosarcoma has responded well to chemotherapy as well, which puts her chance at surviving cancer free at over 80 percent, Letson says.

"It all just came together. Everything was really in her favor," he says.