Rotationplasty

Rotationplasty, commonly known as a Van Nes rotation or Borggreve rotation, is a type of autograft wherein a portion of a limb is removed, while the remaining limb below the involved portion is rotated and reattached. This procedure is used when a portion of an extremity is injured or involved with a disease, such as cancer.[1]

The procedure is most commonly used to transfer the ankle joint to the knee joint following removal of a distal femoral bone tumor, such as osteosarcoma. The limb is rotated because the ankle flexes in the opposite direction compared to the knee. The benefit to the patient is that they have a functioning knee joint to which a prosthetic can be fitted, so that they can run and jump.

History

Rotationplasty was first performed by Borggreve in 1927.[2] He performed the procedure on a 12-year-old boy who suffered from tuberculosis. However, the procedure was not well known until 1950, when Dutch orthopedist Cornelis Pieter van Nes (1897–1972) reported the results of rotationplasty procedures.[3] He became well known for establishing the procedure. Since then, many surgeons have performed modified versions of rotationplasty and have had great success.

Indications

Originally, rotationplasty was performed to treat infections and tumors around the knee. It was also a common treatment for osteosarcoma.[4] While it is still being used to treat their complications, rotationplasty is also used to treat growing children who have been diagnosed with tumors around the knee.[5] Rotationplasty is also performed on children with congenital femoral deficiencies. Those deficiencies cause "unstable hip joint[s] and a femur that is 50% shorter than the contralateral, normal femur."[6] This procedure gives rotationplasty patients the ability to have the use of both feet and allows them to continue living an active lifestyle.

Procedure

In the actual procedure, the bone affected by the tumor, as well as a small part of the healthy femoral and occasionally tibia bone, is removed. A portion of the leg removed; the ankle joint is then turned 180 degrees and is reattached to the thigh. They are held together by plates and screws until they have healed naturally. The surgery can take anywhere from 6 to 10 hours, with a day or two in intensive care.[7] The leg is kept in a cast for 6 to 12 weeks. After the leg has sufficiently healed, the leg can be fitted for a prosthetic.[8]

Advantages and disadvantages

Advantages

Rotationplasty allows the use of the knee joint, whereas amputation would result in loss of that joint. Therefore, it provides a better attachment point and range of motion for a prosthetic limb. As a result, children who have had rotationplasty can play sports, run, climb, and do more than would be possible with a jointless prosthetic. After the procedure, the leg is durable; patients do not typically have to undergo additional surgeries.[9]

Disadvantages

Rotationplasty can result in poor circulation throughout the leg, infection, nerve injuries, bone healing complications, and fracture of the leg.[10] The appearance of the leg after rotationplasty may be considered unusual.

Quality of life

A 2002 study measured life contentment and quality of life in 22 patients who had been recipients of the rotationplasty procedure at least 10 years before. They found that those patients that were younger when the procedure was performed were happier with their lives. It was also found that 8 of the 22 had to have a total of 21 surgical revisions performed in the 10 years. In comparison to the general population, the patients had a higher percentage of quality of life, 83% compared to 75%. Overall, the patients were more content with different aspects of their lives than the general population.[11]

References
  1. Agarwal M, Puri A, Anchan C, Shah M, Jambhekar N (2007). "Rotationplasty for bone tumors: is there still a role?". Clin. Orthop. Relat. Res. 459: 76–81. doi:10.1097/BLO.0b013e31805470f0. PMID 17414168. S2CID 31227954.
  2. Kotz, R. "Rotationplasty." Seminars in surgical oncology 13.1 (1997): 34-40. Print.
  3. Rotation-plasty for congenital defects of the femur, by C. P. van Nes, in the Journal of Bone and Joint Surgery; Volume 32-B, Issue 1 / February 1950
  4. Ramseier, Leonhard E.; Dumont, Charles E.; Ulrich Exner, G. (January 2008). "Rotationplasty (Borggreve/Van Nes and modifications) as an alternative to amputation in failed reconstructions after resection of tumours around the knee joint". Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. 42 (4): 199–201. doi:10.1080/02844310802069434. ISSN 0284-4311. PMID 18763196. S2CID 10486883.
  5. "RotationPlasty : A Surgeon's Approach - The Dynamics of Rotationplasty". www.rotationplasty.org. Retrieved 2020-04-27.
  6. Brown, Kenneth L.B. (January 2001). "Resection, Rotationplasty, and Femoropelvic Arthrodesis in Severe Congenital Femoral Deficiency". The Journal of Bone and Joint Surgery, American Volume. 83 (1): 78–85. doi:10.2106/00004623-200101000-00011. ISSN 0021-9355. PMID 11205862. S2CID 23701234.
  7. Kotz, Rainer (January 1997). "Rotationplasty". Seminars in Surgical Oncology. 13 (1): 34–40. doi:10.1002/(sici)1098-2388(199701/02)13:1<34::aid-ssu6>3.0.co;2-5. ISSN 8756-0437. PMID 9025180.
  8. Kotz, R. "Rotationplasty." Seminars in surgical oncology 13.1 (1997): 34-40. Print.
  9. "RotationPlasty : A Surgeon's Approach - The Dynamics of Rotationplasty". www.rotationplasty.org. Retrieved 2020-04-27.
  10. Hillmann, A.; Gosheger, G.; Hoffmann, C.; Ozaki, T.; Winkelmann, W. (2000-10-17). "Rotationplasty - surgical treatment modality after failed limb salvage procedure". Archives of Orthopaedic and Trauma Surgery. 120 (10): 555–558. doi:10.1007/s004020000175. ISSN 0936-8051. PMID 11110135. S2CID 6829184.
  11. Rödl, Robert W; Pohlmann, Ursula; Gosheger, Georg; Lindner, Norbert J; Winkelmann, Winfried (January 2002). "Rotationplasty--quality of life after 10 years in 22 patients". Acta Orthopaedica Scandinavica. 73 (1): 85–88. doi:10.1080/000164702317281468. ISSN 0001-6470. PMID 11928918. S2CID 30887593.
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