Rotationplasty is a specialized surgical procedure for the lower limb, a unique limb reconstruction technique. It is considered for individuals with significant bone damage or disease around the knee. Unlike traditional amputations, rotationplasty aims to preserve a functional part of the limb, allowing for enhanced mobility and quality of life. The surgery strategically reorients the lower leg, transforming the ankle into a functional knee joint.
Understanding the Procedure
The rotationplasty procedure involves several precise surgical steps. Surgeons remove the diseased or damaged section of the bone, including the lower part of the thigh bone (femur), the knee joint itself, and the upper part of the shin bone (tibia). This ensures any affected tissue is completely excised with a margin of healthy tissue.
After bone removal, the remaining lower leg (ankle and foot) is rotated 180 degrees. This positions the foot backward, allowing the ankle joint to bend in the same direction as a typical knee. The rotated lower leg is then reattached to the remaining upper thigh bone.
Surgeons use plates and screws to fix the reattached bones, providing stability as they heal. The heel of the now backward-facing foot is positioned to align with the opposite knee, ensuring balanced leg lengths when a prosthesis is fitted. This reattachment transforms the ankle into a functional knee joint for integration into a specialized prosthetic limb.
When Rotationplasty is Considered
Rotationplasty is primarily a limb-salvage option for malignant bone tumors that affect the knee area. Pediatric patients, particularly those under 12, are frequent candidates for this surgery due to bone cancers like osteosarcoma and Ewing’s sarcoma.
The procedure is chosen over traditional above-knee amputation or limb-sparing surgeries because it offers distinct advantages, especially for growing children. A key benefit is that the remaining bone in the rotated limb continues to grow with the child, allowing for better adaptation and function over time. This natural growth means fewer prosthetic adjustments and revisions compared to other options.
Rotationplasty preserves the nerves and blood vessels in the lower leg, allowing retained sensation and a more natural control over the new knee joint. This enables a higher level of function, including participation in high-impact activities like running and sports, which might be limited with other types of prostheses. The procedure creates a durable reconstruction with proprioceptive input from the foot, contributing to a better sense of limb position and movement.
Life After Rotationplasty
Recovery after rotationplasty involves a structured process of healing and rehabilitation. Following surgery, patients spend a few days in the hospital. The surgical site is placed in a cast for 6 to 12 weeks to allow bones to heal.
Physical therapy is central to rehabilitation, beginning once initial healing is complete. Therapists guide patients through exercises designed to strengthen the surrounding muscles and improve the range of motion in the newly formed ankle-knee joint. This therapy helps the patient learn to control the rotated ankle, which will function as their new knee.
Once the bone and surgical incision have healed, a specialized prosthesis is custom-fitted to the limb. This prosthesis is designed to encompass the backward-facing foot, allowing the ankle’s natural bending motion to power the prosthetic knee. Patients learn to use their rotated ankle for flexion and extension, enabling movements like walking, running, and climbing.
The functional outcomes of rotationplasty are favorable, with many patients achieving high levels of mobility and participating in physical activities, including competitive sports. While the initial appearance of the rotated limb without the prosthesis can be different, it resembles a standard below-knee amputation when covered by clothing and the prosthetic.
Psychological adaptation is an important aspect of recovery, as patients and their families adjust to the new limb configuration. Support from medical teams, family, and peers assists in navigating body image considerations. The long-term benefits of maintaining a functional, growing limb with sensation outweigh initial cosmetic concerns.