Facilitating rotationplasty

Abstract

Rotationplasty, a unique surgical procedure where the ankle is converted into the knee joint after shortening and 180 degree external rotation of the limb is a well accepted alternative to amputation in musculoskeletal oncology. The required vascular dissection can be quite difficult as the concerned vessels lie in the posterior compartment from the distal third of the thigh downwards. The problem is compounded when rotationplasty is used as a salvage procedure after failed limb-sparing tumor surgery because of the additional fibrosis and stiffness at the level of the prosthetic knee joint. We advocate making the femoral osteotomy at an early stage in the procedure so as to allow free rotation of the distal limb thus making the popliteal fossa and the limb distal to it face anteriorly to facilitate the neuro vascular dissection. We also describe use of a novel cutting jig to ensure a perfect horizontal cut perpendicular to the long axis of the bone while making the femoral and tibial osteotomies. This ensures maximal surface contact between the apposing femoral and tibial cut ends, promoting early bony union.

Musculoskeletal oncology reconstructions in India – Changes in this millennium!

“…Modifications in technique, its use in adults where large tumors often necessitate resection of extensive skin and surrounding soft tissue precluding conventional limb salvage and its use as an option to salvage cases with uncontrolled infection following limb salvage with a prosthesis have expanded the scope of this procedure. 16 Globally, surgeons favour the use of a prosthesis or allograft reconstruction after resection of pelvic tumors involving the acetabulum. In India, patients need to retain the ability to squat or sit on the floor, functions that are not advisable when using a pelvic prosthesis.…”

Rotationplasty Salvage Procedure as an Effective Alternative to Femoral Amputation in an Adult With a History of Osteosarcoma: A Case Report and Review

“…We informed him pre-operatively about the risk of resectionanastomosis, with the help of a vascular surgeon who was available during surgery (35).…”

Limb Salvage for Osteosarcoma: Current Status with a Review of Literature

“…It also works as an excellent salvage option for a failed megaprosthesis, especially after infection. 66 Another advantage is that with large tumors and extensive quadriceps involvement (common in a developing country like India), it can still provide functionally good outcome. An osteotomy of the femur early in the procedure allows limb rotation and makes dissection of the neuro-vascular bundle easier.…”

“…An osteotomy of the femur early in the procedure allows limb rotation and makes dissection of the neuro-vascular bundle easier. 66 A specially designed jig helps to cut the bone perfectly perpendicular to the long axis and makes osteosynthesis between tibia and femur easier. [65][66] .…”

“…66 A specially designed jig helps to cut the bone perfectly perpendicular to the long axis and makes osteosynthesis between tibia and femur easier. [65][66] . Rotationplasty can be performed in even in smaller hospital setups without need for complex instrumentation.…”