Rotationplasty is a surgical option for young children who have been diagnosed with a variety of malignant or benign conditions. Rotationplasty is typically recommended when a portion of the limb is injured or diseased. Rotationplasty is most commonly used as a treatment option for osteosarcoma or Ewing’s sarcoma in the distal femur or proximal tibia, but can also be used in the proximal femur for rotationplasty in the hip.
During the rotationplasty procedure, the bone cancer and surrounding tissues are removed and the remaining lower section of the leg is rotated before being reattached to the healthy upper section. When rotationplasty is performed on the leg, for example, the ankle becomes the knee joint.
A prosthesis is built that allows the foot and ankle to function as the patient’s knee. This prosthesis is different than a typical prosthetic device since it requires consideration of an anatomical ankle to act as the knee. The ankle (new knee) requires structural support so that the patient does not overextend the ankle. Prosthetic fit and function are very critical and should only be performed by a skilled prosthetist.
Patients who undergo rotationplasty as a surgical treatment option require intensive physical therapy to gain motion and strength in the reconstructed limb. A physical therapist and prosthetist who are skilled in this specific design/procedure should work very closely with the patient’s orthopaedic surgeon to guide the exercise program and prosthetic fitting.
Other surgical options for young patients with sarcomas such as osteosarcoma or Ewing’s sarcoma are:
- Limb sparing surgery
- Complete amputation
When making the decision whether to receive rotationplasty versus the other treatment options, parents should take into consideration the age of the child, the location and size of the cancer, medical diagnosis and prognosis as well as the “functional outcomes” that the parents/child/physician agree on.
Rotationplasty is a good option for young patients who have not finished growing and have a malignant bone tumor around the knee joint. Because their legs have not grown completely, the leg length difference will not be as great. Also, the young patient will be able to run and jump and keep up with their friends and classmates. The patient can participate in most sports even those with jumping and high impact. Because the ankle joint is a natural joint functioning as the “new knee,” the patient has greater control of the “knee” with sensation of how it is moving as well as the position of the knee as the patient walks and runs.
Our orthopaedic oncologists at the Emory Orthopaedics & Spine Center work closely with the resources at Children’s Healthcare of Atlanta’s Aflac Cancer and Blood Disorders Center, one of the largest childhood cancer programs in the country. Our continuum of care features pediatric experts in orthopaedic surgery, radiation oncology, social work, case management, physical therapy and prosthetics.