Rotationplasty
Rotationplasty, commonly known as a Van Nes rotation or Borggreve rotation, is a type of autograft wherein a portion of a limb is removed, while the remaining limb below the involved portion is rotated and reattached. This procedure is used when a portion of an extremity is injured or involved with a disease, such as cancer.[1]
The procedure is most commonly used to transfer the ankle joint to the knee joint following resection of a distal femoral bone tumor, such as osteosarcoma. The limb is rotated because the ankle flexes in the opposite direction compared to the knee. The benefit to the patient is that they have a functioning knee joint and can run and jump.
The operation is also called a Van Nes rotation,[2] in honor of its inventor, Dutch orthopedist Cornelis Pieter van Nes (1897–1972).[3]
Overview
Reasons
Originally, rotationplasty was performed to treat infections and tumors around the knee. It was also a common treatment for osteosarcoma.[4] While it is still being used to treat their complications, rotationplasty is also used to treat growing children who have been diagnosed with tumors around the knee.[5] Rotationplasty is also performed on children with congenital femoral deficiencies. Those deficiencies cause "unstable hip joint[s] and a femur that is 50% shorter than the contralateral, normal femur."[6] This procedure gives rotationplasty patients the ability to have the use of both feet and allows them to continue living an active lifestyle.
History
Rotationplasty was first performed by Borggreve in 1927.[7] He performed the procedure on a 12-year-old boy who suffered from tuberculosis. However, the procedure was not well known until 1950. At that time, physician Van Nes reported the results of rotationplasty procedures. He became well known for founding the procedure. Since then, many surgeons have performed modified versions of rotationplasty and have had great success.
Procedure
In the actual procedure, the bone affected by the tumor, as well as a small part of the healthy femoral and occasionally tibia bone, is removed. A portion of the leg removed; the ankle joint is then turned 180 degrees and is reattached to the thigh. They are held together by plates and screws until they have healed naturally. The surgery can take anywhere from 6 to 10 hours, with a day or two in intensive care.[8] The leg is kept in a cast for 6 to 12 weeks. After the leg has sufficiently healed, the leg can be fitted for a prosthetic.[9]
Advantages and disadvantages
In the same scenario, amputation would not leave a knee joint. Rotationplasty allows the use of a knee joint. Furthermore, it provides a better position for a prosthetic limb. As a result, children who have had rotationplasty can play sports, run, climb, etc. Rotationplasty is also durable.[10] Patients do not typically have to undergo additional surgeries throughout their lives. Unfortunately, not every case turns out favorably. Rotationplasty can result in problems with blood supply to the leg, infection, nerve injuries, problems with bone healing, and fracture of the leg.[11] Also, the appearance of the leg after rotationplasty can be considered unusual.
Quality of life
German orthopedists Robert W Rödl, Ursula Pohlmann, Georg Gosheger, Norbert J Lindner, and Winfried Winkelmann evaluated a study that measured life contentment and quality of life in 22 patients who had been recipients of the rotationplasty procedure at least 10 years before. They found that those patients that were younger when the procedure was performed were happier with their lives. It was also found that 8 of the 22 had to have a total of 21 surgical revisions performed in the 10 years. In comparison to the general population, the patients had a higher percentage of quality of life, 83% compared to 75%. Overall, the patients were more content with different aspects of their lives than the general population.[12]
References
- Agarwal M, Puri A, Anchan C, Shah M, Jambhekar N (2007). "Rotationplasty for bone tumors: is there still a role?". Clin. Orthop. Relat. Res. 459: 76–81. doi:10.1097/BLO.0b013e31805470f0. PMID 17414168.
- Banaś B, Kowalczyk B (2006). "[A strategy of rehabilitation in children with proximal femoral focal deficiency treated with modified Van Nes rotationplasty]". Chirurgia Narzadów Ruchu I Ortopedia Polska (in Polish). 71 (4): 313–5. PMID 17455533.
- Rotation-plasty for congenital defects of the femur, by C. P. van Nes, in the Journal of Bone and Joint Surgery; Volume 32-B, Issue 1 / February 1950
- Ramseier, Leonhard E.; Dumont, Charles E.; Ulrich Exner, G. (January 2008). "Rotationplasty (Borggreve/Van Nes and modifications) as an alternative to amputation in failed reconstructions after resection of tumours around the knee joint". Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. 42 (4): 199–201. doi:10.1080/02844310802069434. ISSN 0284-4311. PMID 18763196.
- "RotationPlasty : A Surgeon's Approach - The Dynamics of Rotationplasty". www.rotationplasty.com. Retrieved 2019-06-20.
- Brown, Kenneth L.B. (January 2001). "Resection, Rotationplasty, and Femoropelvic Arthrodesis in Severe Congenital Femoral Deficiency". The Journal of Bone and Joint Surgery, American Volume. 83 (1): 78–85. doi:10.2106/00004623-200101000-00011. ISSN 0021-9355. PMID 11205862.
- Kotz, R. "Rotationplasty." Seminars in surgical oncology 13.1 (1997): 34-40. Print.
- Kotz, Rainer (January 1997). "Rotationplasty". Seminars in Surgical Oncology. 13 (1): 34–40. doi:10.1002/(sici)1098-2388(199701/02)13:1<34::aid-ssu6>3.0.co;2-5. ISSN 8756-0437. PMID 9025180.
- Kotz, R. "Rotationplasty." Seminars in surgical oncology 13.1 (1997): 34-40. Print.
- "RotationPlasty : A Surgeon's Approach - The Dynamics of Rotationplasty". www.rotationplasty.com. Retrieved 2019-06-20.
- Hillmann, A.; Gosheger, G.; Hoffmann, C.; Ozaki, T.; Winkelmann, W. (2000-10-17). "Rotationplasty - surgical treatment modality after failed limb salvage procedure". Archives of Orthopaedic and Trauma Surgery. 120 (10): 555–558. doi:10.1007/s004020000175. ISSN 0936-8051. PMID 11110135.
- Rödl, Robert W; Pohlmann, Ursula; Gosheger, Georg; Lindner, Norbert J; Winkelmann, Winfried (January 2002). "Rotationplasty--quality of life after 10 years in 22 patients". Acta Orthopaedica Scandinavica. 73 (1): 85–88. doi:10.1080/000164702317281468. ISSN 0001-6470. PMID 11928918.
External links
- Saving Lives ... And Limbs—In-Depth Doctor's Interview, John Dormans, M.D.
- Know Your Options: An Explanation of the Rotationplasty and Tibia Turn-Up Procedures, inMotion, March/April 2005 - with images
- Sheena Goodyear (27 April 2018). "Girl whose leg was amputated and reattached backwards hopes to dance again". cbc.ca. Canadian Broadcasting Corporation.