Surgical Procedures: Rotationplasty
What is rotationplasty?
Rotationplasty is a procedure that can be used in the treatment of bone cancer (osteosarcoma or Ewing sarcoma) in the area of the knee or knee joint. The bottom of the femur (the long bone in the thigh), the knee, and the upper tibia (bone below the knee) are surgically removed. The lower leg is then rotated or turned 180 degrees (to face backward), which is why it's called rotationplasty. The lower leg is then attached to the femur.
Rotationplasty is most often 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 learn and adapt to the new function of the ankle.
Some older children or adults may also be able to have rotationplasty. This procedure may be used for those who would need 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 needed for ankle/foot function.
How is it done?
During a rotationplasty, the part of the leg and thigh bones containing the tumor is removed, along with some healthy bone to obtain “clean margins.” This often includes some of the lower part of the femur bone (thigh), the knee joint, and some 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 backward, creating a new “knee joint” and attached to the thigh (femur).
The attached ankle joint will act as a new knee, and the backward-facing foot will fit into a custom-fit artificial lower limb.
What are the benefits of rotationplasty?
Because children continue to grow until adulthood, one benefit to this type of procedure is that the bone will continue to grow with them. This helps them to be physically active. The prosthetic leg used with rotationplasty will be fitted and changed as they grow.
Alternatives to rotationplasty include a prosthetic knee and amputation. This limits the patient’s activity and the sports and strenuous activities the person can do. When a child needs a prosthetic knee, multiple surgeries are often needed over their growing years.
Many children who have 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 (pain after amputation where the limb was removed) is not a side effect of this type of surgery. In order for a patient to be able to have this surgery, sciatic and other vital lower leg nerves must be intact and working.
What are the risks of having rotationplasty?
As with any surgical procedure, there are risks and side effects of having a rotationplasty. This is a highly specialized procedure that is not done very often. It is important to have the surgery done at a specialty center with experience in doing the procedure.
Risks and side effects of having a rotationplasty can depend on the procedure, as some patients may need more extensive reconstruction of blood vessels. General risks may be:
- Reactions to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions can include wheezing, rash, swelling, and low blood pressure) and other medications.
- Bleeding, blood clots.
- Infection, wound healing problems.
- Injury to nerves or problems with the blood supply to the grafted lower leg.
- Poor bone fusion leading to more surgery.
What is recovery like?
Recovery from a rotationplasty will require a stay in the hospital, often 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 some time and effort from the patient. The length of therapy can vary from patient to patient. As the child grows, they will need a new prosthesis and may need short stints of physical therapy with each new prosthesis.
Physical therapy meets with the patient and family before the procedure to test the patient’s needs and what they hope to achieve after the procedure. They will talk in more detail about what to expect after surgery and in the future.
Rotationplasty may be an option for some patients with bone tumors in the leg. It can be a hard 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.
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