Rotationplasty (Borggreve/Van Nes and modifications) as an alternative to amputation in failed reconstructions after resection of tumours around the knee joint

Abstract

Failure of reconstructions as a result of infective or aseptic loosening and massive bone loss may make amputation necessary. If neurovascular structures can be preserved to keep a functional foot, rotationplasty may be considered an option. Four patients treated for malignant bone tumours (two osteosarcomas, one Ewing sarcoma, and one malignant fibrous histiocytoma) of the proximal tibia and distal femur (n=2 each) at the ages of 13 to 21 years had reconstructions that failed 3, 4, 5, and 15 years later. In three patients the cause was intractable infection, and in one loosening with shortening and deficiency of the extensor mechanism. The patients had the option to contact patients who had had rotationplasty as the primary procedure for tumours or severe femoral deficiencies. In two patients an AI-type rotationplasty was done, in one a type AII rotationplasty, and in the fourth a modification with shortening of the lower leg but retention of the knee joint. There were no postoperative complications such as persisting infections, fractures, or pseudarthrosis. All patients are active and are able to go alpine skiing or snowboarding. The main advantage of procedures in which a sensory-motor functional foot is retained is to avoid neuroma pain or phantom sensations. The foot allows for active knee movement of the orthoprosthesis and full weight bearing. It is of great psychological help for the patients to have contact during the decision-making with patients who have had similar procedures. It should be considered as an alternative to amputation.

Proximal Tibia Reconstruction After Bone Tumor Resection: Are Survivorship and Outcomes of Endoprosthetic Replacement and Osteoarticular Allograft Similar?

“…However, the proximal tibia is a challenging anatomic site for extremity reconstructions after bone tumor resection and it is associated with a high incidence of surgical complications [6,18,20,[22][23][24]. Functional reconstructive options for large defects in the proximal tibia include biological reconstruction (transplantation of a structural allograft), endoprosthetic replacement, and composite reconstruction with use of an allograft and a knee prosthesis.…”

Amputation and rotationplasty in children with limb deficiencies: Current concepts

“…The advantages and disadvantages of the different choices (amputation, reconstruction and lengthening, or prosthetic fitting without surgery) should be elicited in terms of the amount of time and effort to invest, the physical and psychological impact of the proposed procedure and the expected impact on quality of life during childhood and the quality of life in the long run. The role of other families who went through the same procedures is of utmost importance [6]. Costs of repeated surgical procedures are expensive, but in the long run, it is probably less expensive than lifelong prosthetic provisions [7].…”

Postoperative Tumor Imaging

“…11 In addition, rotationplasty can be used in patients with failed reconstructions after resection of tumors around the knee. 12 Although cosmetically deforming, rotationplasty is a reasonable alterative to amputation, arthrodesis, or endoprosthesis because of its superior function. Rotationplasty allows active movement of the knee by the rotated foot with preserved sensation.…”