Rotationplasty is a specialized surgical technique that involves the rearrangement of a patient’s lower limb to preserve function after the removal of a diseased or damaged section. This reconstruction procedure is a form of limb salvage, used as an alternative to a high-level amputation, often in cases where the knee joint itself must be removed. It utilizes a patient’s own tissues and joints in a novel way to create a durable, biological replacement for a lost limb segment.
Defining Rotationplasty
Rotationplasty removes a segment of the leg, typically encompassing the knee joint, and reattaches the remaining lower portion after rotating it 180 degrees. The surgeon removes the affected bone (usually the distal femur and/or proximal tibia) along with the associated soft tissues and knee joint. The remaining lower leg (tibia, fibula, ankle, and foot) is turned completely backward and fixed to the upper thigh bone, or femur. This reattached foot, now pointing behind the patient, is fitted into a custom prosthetic socket. The procedure’s primary purpose is functional, allowing the ankle joint to serve as a replacement for the removed knee joint within the prosthesis.
The Historical Origin and Key Figures
The initial concept for rotationplasty pre-dates its modern application in oncology. The procedure is credited to German surgeon Dr. Joseph Borggreve, who first performed the operation in 1927 on a 12-year-old boy suffering from tuberculosis. Borggreve’s goal was to replace the destroyed knee with the ankle to create a functional joint for a prosthetic fitting. The technique gained wider recognition and refinement through Dutch orthopedic surgeon Dr. Cornelis Pieter van Nes in the 1950s, who popularized the procedure for patients with congenital femoral deficiency. The procedure is frequently referred to as the Borggreve-Van Nes rotationplasty, acknowledging both the originator and the figure who refined its technique.
The Biomechanical Mechanism of Function
The success of rotationplasty lies in joint substitution, transforming the ankle’s natural movements into the necessary action for a prosthetic knee. After the 180-degree rotation, the ankle joint is positioned near the level of the opposing knee. In this reversed orientation, plantarflexion (pointing the toes downward) extends the prosthetic knee, while dorsiflexion (pulling the toes upward) translates into prosthetic knee flexion. This allows the patient to actively control the prosthetic limb’s movement, providing stability and a greater range of motion than a passive mechanical knee. Crucially, major nerves and blood vessels are preserved during the surgery, allowing the patient to retain sensation and proprioception in the foot. This provides sensory feedback and control to the “new” knee that is often absent in high-level amputations.
Evolution and Primary Applications
The procedure has evolved from treating infection and congenital defects to becoming a standard option in pediatric oncology. Today, rotationplasty is primarily utilized as a limb-salvage option for children and adolescents diagnosed with bone tumors, such as osteosarcoma, located near the knee. Rotationplasty is often preferred in young patients because it preserves the biological integrity of the limb, allowing the bone to continue growing with the child. This is an advantage over non-growing internal prostheses, which require multiple lengthening procedures as the child matures. The long-term functional outcome with a well-adapted prosthesis is high, frequently allowing patients to participate in running, sports, and other high-impact activities.