A Surgeon's Approach - The Dynamics of Rotationplasty

Dr. Mark Scarborough has performed about 15 rotationplasty procedures, while his partner has done about ten. Dr. Scarborough began performing rotationplasty procedures  in 1990.

Rotationplasty of the lower extremity is a functional surgical option for children undergoing resection of a malignant bone tumor around the knee. Originally described for the treatment of infections and congenital limb deformities, it is now used primarily as a reconstructive option for children who are not done growing, who are diagnosed with a malignant bone tumor around the knee joint. Other common surgical options include amputation or a metal joint reconstruction.

Rotationplasty involves removing the area of bone affected by the tumor along with some normal bone, to ensure there is a “clear margin.” This usually involves removing a portion of the femur (thigh bone) and a portion of the tibia (shin bone). Once the tumor is removed, the remaining leg is rotated 180 degrees and reattached to the thigh. The femur and tibia bones are attached to each other with a plate and screws to hold them in place until healing occurs. This gives the appearance of a short leg with the foot on backwards. The foot and ankle then function as a knee joint, allowing the patient to wear a more functional prosthesis.

The surgical procedure itself takes anywhere from 6-10 hours to complete. Following surgery, your child is usually admitted to the intensive care unit for 24-48 hours. This is to ensure close monitoring of the blood supply to the foot. The length of hospital stay also varies, but is usually anywhere from 5-7 days. Your child is usually placed into a cast, which will remain on anywhere from 6-12 weeks, or potentially longer, depending on how quickly the bones heal together. Children who are receiving chemotherapy usually take longer to heal, so the time your child will spend in a cast will vary greatly, depending on the healing response. Once the doctor feels the bones and surgical incisions have healed adequately, your child can be fitted for a prosthesis.

The advantages of rotationplasty when compared to an amputation are a functioning joint at the level of the knee, which allows for a smaller and better functioning prosthesis. This allows children better function when participating in sports, as well as day to day activities. The main advantage of rotationplasty over prosthetic replacement is the durability of the procedure. Children who undergo prosthetic replacement, especially those with a significant amount of growth left, will likely require additional surgical procedures throughout their lifetime as a result of limb length discrepancy, and prosthesis failure. Also, there are significant activity restrictions placed on children whom have undergone prosthetic replacement, and their participation in sports is extremely limited. The main disadvantage of rotationplasty when compared to these other procedures is the appearance of the limb.

There are potential complications associated with rotationplasty as well. These included problems with the blood supply, infection, nerve injuries, inability to heal the bone, and fracture of the leg. That being said, most children who undergo rotationplasty do not require any additional surgery. Rotationplasty is a durable and functional surgical option for children with a bone tumor around the knee.

Written by Dr. Emily Soni, MD, Orthopaedic Oncology Fellow, University of Florida on behalf of Mark T. Scarborough, M.D. Eugene L. Jewett Professor of Orthopaedic Surgery, Division Chief: Orthopaedic Oncology, Orthopaedics and Sports Medicine Institute, University of Florida (photo above)