Surgical Procedures: Rotationplasty
What is a rotationplasty and when is it used?
Rotationplasty is a surgical procedure that can be used in the treatment of a bone cancer (osteosarcoma or Ewing sarcoma) in the area of the knee or knee joint. It is most commonly used in children under 12 years of age, because the bones will continue to grow, making it a good option for children who are still growing. Young children are also better able to adapt to and learn the new function of the ankle.
Some older children or adults may also be candidates for a rotationplasty. This procedure may be recommended for those who would otherwise require an above the knee amputation due to the size of the tumor. One important factor is that the nerves can be saved, as they are required to maintain the ankle/foot function.
How is the procedure done?
During a rotationplasty, the portion of the leg and thigh bones containing tumor are removed, along with some healthy bone to obtain “clean margins”. This typically includes a portion of the lower part of the femur bone (thigh), the knee joint and a portion of the top of the lower leg (tibia). The lower part of the leg, including the foot and ankle are then rotated 180 degrees to face backwards, creating a new “knee joint” and attached to the thigh (femur).
The attached ankle joint will act as a new knee, and the backwards facing foot will fit into a custom-fit artificial lower limb.
What are the benefits of the procedure?
Because children continue to grow until adulthood, one benefit to this type of procedure is that the bone will continue to grow with them and they can be physically active. The prosthetic leg used with rotationplasty will be fitted and altered throughout their growing years.
Alternatives to rotationplasty include a prosthetic knee and amputation, both of which limit the patient’s activity and have restrictions on sports and strenuous activities. In the case of the prosthetic knee, multiple surgeries are often required over the child’s growing years.
Many children who undergo rotationplasty continue to be active, participating in physical activities such as soccer, basketball, running, skiing, bicycling, and more.
In addition, rotationplasty maintains nerve and blood vessel function, so phantom limb pain is not a side effect of this type of surgery. In order for a patient to be a candidate for this surgery, sciatic and other vital lower leg nerves must be intact and functional.
What are the risks associated with rotationplasty?
As with any surgical procedure, there are risks and side effects associated with undergoing a rotationplasty. This is a highly specialized procedure that is not performed very often. Therefore it is important to have the surgery done at a specialty center with experience in doing the procedure.
Risks and side effects associated with a rotationplasty can depend on the procedure, as some patients may require more extensive reconstruction of blood vessels. General risks may include:
- Reactions to anesthesia and medications
- Bleeding, blood clots
- Infection, wound healing problems
- Injury to nerves or problems with the blood supply to the grafted lower leg
- Inadequate bone fusion requiring additional surgery
What is recovery like?
Recovery from a rotationplasty will require a stay in the hospital, typically up to a week. Most patients will go home in a cast. The length of time in the cast will depend on how the bone heals. If the patient is receiving chemotherapy, healing may take longer. Once the bone and wounds have healed, the child can be fitted for the lower leg prosthesis. During this time, the patient may need crutches or a wheelchair to get around.
Physical therapy is a key part of recovery. Therapy helps the patient learn to use the ankle joint as a knee joint, how to walk with the new leg/prosthesis, and how to wear and adjust the prosthesis. This takes a considerable amount of time and effort from the patient and the length of therapy can vary from patient to patient. As the child grows, they will need a new prosthesis and may require short stints of physical therapy with each new prosthesis.
Physical therapy meets with the patient and family before the procedure to evaluate the patient’s needs and what they hope to achieve after the procedure. They will discuss in more detail what to expect after surgery and in the future.
In conclusion, rotationplasty may be an option for some patients with bone tumors in the leg. It can be a difficult concept to understand, particularly when faced with all that comes with a new cancer diagnosis. Use the resources below to learn more about rotationplasty, see how other patients are doing after the procedure, and connect with providers who do this procedure.
Resources for more information
Rotationplasty video from Boston Children’s Hospital
Rotationplasty…a 180° difference – a site run by families to help families learn about the procedure.
My Backwards Foot: Sean’s Rotationplasty – a video about a young boy’s treatment for sarcoma, including rotationplasty.
Rotationplasty. (n.d.) Retrieved from http://www.danafarberbostonchildrens.org/why-choose-us/expertise/surgery/rotationplasty.aspx
Rotationplasty-Mayo Clinic. (Sep 3, 2010) Retrieved from https://www.youtube.com/watch?v=njJUcTbR2SY
Rotatinplasty (definition) Retrieved from https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=693564
Fuchs B, Sim FH. Rotationplasty about the knee: surgical technique and anatomical considerations. Clin Anat. 2004 May;17(4):345-53. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15108342