What is Rotationplasty?

What is Rotationplasty?
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Full amputation of a lower leg is often carried out as a treatment for certain types of cancer, in particular osteosarcoma. An amputation can save the live of a person with this cancer, yet the loss of the limb is an emotional and physical stressor that is difficult to overcome.

The Rotationplasty Procedure

During a rotationplasty, the affected leg is partially amputated just above the knee. Once this has been done, the leg and foot are rotated 180 degrees. Next, the length of the leg is adjusted if necessary, and the top of the tibia is fused to the bottom of the femur.

Once this portion of the procedure is completed, the knee has been removed, and the foot is located approximately where the knee previously was. The foot is placed backwards, so that the heel part of the foot now acts as a knee joint to provide the leg with some flexibility.

The main advantage of the procedure is that patients have a more stable limb which can better adjust to the use of a prosthetic device. In addition, the patient retains their foot and toes, which is useful because they provide the brain with sensory feedback. Finally, this approach prevents the development of phantom pain after surgery – a condition which can be highly distressing for people who suffer from it.

Risks and Complications of Rotationplasty

There are several risk factors and complications that often prohibit the use of rotationplasty as an alternative to full amputation.

One possible complication of the procedure is a compromised vascular system, as a result of the joining of the femoral artery to the lower limb. If the vascular system is severely compromised, the affected limb may need to be fully amputated.

People who undergo rotationplasty due to traumatic injury risk further complications following surgery, as do people who undergo the procedure as a treatment for osteosarcoma. In these cases the limb’s ability to drain and recirculate fluid is often compromised, leading to an increased risk of post-operative limb failure.

References

Ebeid, W. and Amin, S. Rotationplasty, an ideal operation for treatment of malignant bone tumours of the femur in children and in patients with pathological fractures.

Kevin Carroll, MS, CP, FAAOP. An Explanation of the Rotationplasty and Tibia Turn-Up Procedures.

Sawamura C, Hornicek FJ, Gebhardt MC. Complications and risk factors for failure of rotationplasty: review of 25 patients. Clinical Orthapedic and Related Research. 2008 Jun;466(6):1302-8. Epub 2008 Apr 11.