Rotationplasty

• Rotationplasty is a limb-salvage surgery for bone tumors, often in children, that preserves function.
• It involves removing the knee joint and tumor, then reattaching the lower leg rotated 180 degrees.
• The ankle joint, after rotation, functions as the new knee joint, allowing for a highly functional prosthesis.
• Benefits include improved mobility and weight-bearing compared to traditional amputation.
• Recovery is intensive, requiring extensive physical therapy and adaptation to a specialized prosthesis.

What is Rotationplasty and How Does it Work?

Rotationplasty is an orthopedic surgical technique designed to treat malignant bone tumors, such as osteosarcoma or Ewing sarcoma, typically located around the knee joint. This procedure is often considered for children and adolescents when limb salvage is desired but a conventional reconstruction is not feasible or would result in poor function. The primary goal is to provide a functional limb that can effectively use a prosthesis, enabling patients to maintain an active lifestyle.

The Rotationplasty procedure explanation involves several critical steps. First, the surgeon carefully removes the cancerous section of bone, including the knee joint and parts of the femur and tibia. Next, the remaining lower leg and foot are rotated 180 degrees and reattached to the healthy upper thigh bone. This rotation positions the ankle joint at the level of the original knee, allowing the ankle to function as a new knee joint within a prosthetic limb. The foot, now facing backward, fits into a custom-designed prosthesis, with the ankle acting as a hinge. This ingenious anatomical rearrangement provides a strong, weight-bearing limb with active control over the prosthetic knee, which is superior to many other limb-salvage options in terms of functional outcome.

Benefits and Risks of Rotationplasty

The decision to undergo Rotationplasty involves a careful consideration of its unique advantages and potential complications. This procedure offers significant functional benefits, particularly for young, active individuals, but also carries inherent surgical risks and challenges related to body image.

The primary benefits of rotationplasty include:

• Enhanced Mobility: Patients often achieve a higher level of mobility and participation in activities, including sports, compared to those with traditional above-knee amputations.
• Improved Prosthetic Function: The rotated ankle provides active control over the prosthetic knee, allowing for a more natural gait and better balance.
• Weight-Bearing Capacity: The limb retains its ability to bear weight directly through the bone, which is crucial for long-term comfort and function with a prosthesis.
• Growth Potential: In growing children, the remaining bone can continue to grow, potentially reducing the need for repeated prosthetic adjustments.

However, like any major surgery, there are risks associated with the benefits and risks of rotationplasty. These can include surgical complications such as infection, bleeding, nerve damage, or issues with bone healing (non-union). Patients may also experience phantom limb pain or discomfort. A significant challenge can be the cosmetic appearance of the rotated limb, which may require psychological adjustment and support. The unique appearance can be a source of self-consciousness, especially during adolescence.

Recovery and Rehabilitation After Rotationplasty

The recovery time after rotationplasty is a comprehensive and multi-stage process that demands significant commitment from the patient and a multidisciplinary healthcare team. Immediately following surgery, patients typically remain in the hospital for several days to a week for pain management, wound care, and initial monitoring. The limb will be immobilized to allow for proper bone healing at the reattachment site.

Once discharged, the rehabilitation phase begins, focusing on strengthening, flexibility, and adaptation. Physical therapy is crucial, initially concentrating on maintaining range of motion in the hip and the newly formed ankle joint. As healing progresses, patients are fitted with a custom-designed prosthesis. Learning to walk and perform daily activities with the rotated limb and prosthesis is a gradual process, often requiring months of intensive therapy. Gait training, balance exercises, and strengthening of the surrounding muscles are key components. Occupational therapy may also be involved to help patients adapt to their new body mechanics and regain independence in daily tasks. Long-term follow-up is essential to monitor prosthetic fit, address any complications, and ensure optimal functional outcomes.