Rotationplasty defines a form of reconstructive surgery of the lower leg performed in lieu of total amputation. The procedure creates a knee joint from the ankle and foot on the affected leg so a prosthesis can be attached. The ankle joint is rotated 180 degrees before muscle, nerves, and blood vessels are reconnected. Rotationplasty might allow patients to retain part of the leg and engage in more physical activity after removal of a tumor near the knee cap.
A surgeon performing this procedure typically removes the infected thigh bone, along with a section of the shin bone if cancer has spread. Some nearby healthy bone might also be removed to ensure all cancer cells are excised. The remaining pieces of both bones are connected with surgical plates and screws to keep them stable.
When the surgeon rotates the ankle and foot joint, with the foot facing the back of the body, it serves as a knee joint. Rotationplasty represents a typical surgery performed on children whose bones are still growing, and might allow them to participate in organized sports. The toes of the foot can be attached to a special prosthesis that is smaller and more comfortable than devices used after complete amputation.
The surgery might take 10 hours or more as the surgeon attaches blood vessels, muscle, tendons, and nerves. A patient remains in a cast after the procedure until bones heal. If chemotherapy treatments continue after surgery to kill any remaining cancer cells, the healing time might take longer. During the recovery period, the patient is monitored for adequate blood flow to the rotationplasty site.
This surgery might be used in patients with osteosarcoma, a bone cancer that commonly develops during the teen years. Before rotationplasty was perfected in the 1970s, the only option available to patients with bone cancer near the knee was amputation. Prosthetic knees were often implanted if enough muscle remained, but these plastic and metal devices wore out from abrasion with bone. Earlier forms of surgery also created noticeable differences in leg length as a child grew.
Before rotationplasty, doctors used formulas to estimate growth of the healthy leg and adjust placement of the ankle joint to compensate. As the patient grows, prosthetic devices on the lower leg can be changed. One disadvantage of this type of surgery centers on the appearance of an ankle and foot where the knee once existed. Some patients might also limp after surgery.