When Your Ankle Becomes a Knee – Long-Term Functional Outcome and Quality of Life with a Rotationplasty after Resection of Malignant Limb Tumors

Abstract

Background Increasing numbers of patients surviving malignant bone tumors around the knee joint have led to an increasing importance to investigate long-term results. This study assessed the long-term results of rotationplasty after resection of malignant bone tumors regarding functional outcome and quality of life to allow better comparison with other treatment options in bone cancer treatment. Procedure 60 participants who underwent rotationplasty due to bone cancer took part in this multicentric questionnaire-based study. The long-term functional outcome was measured by the Musculoskeletal tumor society score (MSTS) and the Tegner activity level scale. The health-related quality of life (HRQL) was assessed by using the Short Form Health Survey (SF-36). Results Patients treated with rotationplasty (median follow-up of 22 years, range 10–47 years) regained a high level of activity (median MSTS score of 24). Even a return to high level sports was possible (mean Tegner activity level scale of 4). Duration of follow-up did not influence the functional outcome. HRQL scores were comparable to the general German population. Concerns of psychological problems due to the unusual appearance of the rotated foot have not been confirmed. Conclusion Rotationplasty can be a good alternative to endoprosthetic replacement or amputation, either as primary surgery or as a salvage procedure. Especially for growing children and very active patients rotationplasty should be considered.

Progress in muscle strength of the reconstructed knee and quality of life of the patient after knee rotationplasty: A case report

“…Regarding MSTS, previous studies reported varied results. 2,3,6,8,10-13 Considering that our patient reached a high level of function during POMs 6–12 (i.e., over a relatively short period), it can be inferred that the post-KRP rehabilitation protocol applied is beneficial in improving physical function. Furthermore, TESS gradually improved in response to muscle strength and physical function.…”

Distal Femoral Focal Deficiency

“…In addition, the family was worried about the psychological burden of the unusual appearance of the limb after rotationplasty, although published literature does not support these concerns. 15 , 16 …”

“…In addition, the family was worried about the psychological burden of the unusual appearance of the limb after rotationplasty, although published literature does not support these concerns. 15,16 Although reconstructive procedures were initially considered, amputation was chosen for several reasons. First, the range of motion in the knee was markedly limited and the extensor force was basically nonexistent.…”

Management of Ipsilateral Fractures After Rotationplasty

“…The advancement of modern treatment regimens, such as neoadjuvant and adjuvant therapy, has significantly improved overall survival rates in recent decades 6 , making long-term followup even more critical. People with rotationplasty can lead active and fulfilling lives, including participating in sports [7][8][9][10][11] . However, engaging in high-impact physical activities may increase the risk of fractures in the reoriented lower leg.…”