Rotationplasty

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.

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.

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]

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.

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]