What is rotationplasty?
Rotationplasty is a procedure used to treat cancerous tumors that appear on the femur or tibia bone in a patient. The procedure involves removing the affected bones and knee joint, turning the ankle joint 180 degrees, and attaching it to where the knee would normally be.
Why is the procedure performed?
This procedure is performed for two main reasons. The first of these is to treat the cancer itself, as the diseased bone must be removed in order to make sure that it does not spread farther up the leg and eventually grow out of control. Although rotationplasty addresses this by removing the diseased bone, its primary focus is reason number two – enabling the patient to move on their own more easily.
Rotationplasty enables the patient to move more easily through their ankle joint. This is because as a part of removing the diseased bone, the knee joint must also be removed, making moving around a lot more difficult. This is generally why you sometimes hear medical professionals wanting to amputate below the knee, as a below the knee prosthesis is easier to operate and requires much less physical effort than an above the knee prosthetic.
Because the ankle rotated 180 degrees, it operates in the exact same way as a knee joint. This is the main pro of rotationplasty – as even though the cancer (usually either a Ewing sarcoma or osteosarcoma) is on the upper tibia or femur, which is above the knee, the patient can still have the convenience of having a below the knee prosthetic with their ankle acting as a stand in.
Who usually has this surgery, and who performs it?
Rotationplasty is usually seen in young children because their potential for growth makes other options unviable, and because they can usually learn how to wire their brain to use the prosthesis better than adults.This procedure is usually performed by an orthopedic surgeon, as these surgeons primarily specialize in bones, joints and muscles. Although rotationplasty is a generally successful procedure (88% success rate), it is not 100%, and the odds are that an orthopedic surgeon would be far better suited to this procedure than most others.
How is this procedure performed?
Rotationplasty is performed in 2 major parts:
- The knee joint and the diseased portion of bone are removed from the leg.
When the affected bones and the knee are removed, the surgeon must be careful to keep the major nerve, artery, and vein that travels from the upper leg to the foot intact. This is in order to make sure that the patient can still have full control of their ankle, along with keeping it well-circulated and supplied with blood.
- The ankle joint is rotated 180 degrees and attached to where the knee once was.
With the knee joint and diseased bone now removed, the surgeon may move onto attaching the rotated ankle to the upper leg (as pictured below).
Because the patient usually still has a lot of growing left to do (as almost all of them are younger children), the surgeon will attach the ankle a little bit below where the other knee is, so that when the child is finished growing, the length of the two will match. As the child grows, the prosthesis’ length/size can be altered.
Post-operation and recovery
The post-operative and recovery of rotationplasty does not have many outstanding aspects. The patient rests for 3 weeks until fitted with an appropriately sized prosthetic, at which point they may have physical therapy sessions in order to re-learn how to walk with their newly attached replacement knee joint, although for most patients this process of learning how to move on their own again is extremely quick.
Final thoughts
Rotationplasty is a procedure that has changed many young lives throughout its existence. Although it is a decently rare procedure to come across, in the right circumstance rotationplasty can be life altering. The difference in the ability to move by oneself with relative ease rather than being assisted in moving around cannot be understated, as this procedure lasts a lifetime, and the boost in quality of life makes this procedure an ideal choice for many.
Sources:
https://www.medicalnewstoday.com/articles/314009#1)-Rotationplasty:-Turning-an-ankle-into-a-knee
https://www7.aaos.org/member/directory/definition.htm#:~:text=Orthopaedic%20surgeons%20are%20devoted%20to,Hip%20and%20knee
https://www.cnn.com/videos/health/2016/02/29/exp-turning-points-sean-dever-rotationplasty.mayo-clinic
Learning Medicine 