Rotationplasty - A Complete Guide

What Is Rotationplasty?

Rotationplasty is the surgical amputation of the middle part of the leg, which includes the entire knee portion along with some portion of thigh (femur) bone. It is mostly carried out in growing children who are affected with malignant (cancerous) tumors like osteosarcoma (cancer that begins in bones) and Ewing's sarcoma (a rare form of cancer affecting the bones and its surrounding tissues). During the surgical process, the surgeon removes the entire knee portion, and the leftover lower part of the leg (including the ankle and foot) is reattached to the remaining thigh bone in 180-degree angulation, where the foot appears backward.

Who Are Indicated for Rotationplasty?

Rotationplasty is mostly carried out in growing young children who are facing:

• Bone cancers such as osteosarcoma and Ewing's sarcoma.

• Inborn (congenital) leg defects.

• Accidental leg fractures.

• Prosthesis infections around knees.

How Is Rotationplasty Carried Out?

The person undergoing rotationplasty should undergo the following procedures, which include:

• First Visit: The team of doctors who are performing rotationplasty must interact with the patient and their family members. During this interaction, the whole procedure of rotationplasty, including the prosthetic part, should be clearly explained to the patient and the attendants. During this visit, challenges faced regarding society, psychological and physical, must be clearly explained.

• Examination: During this patient, the patient is checked for blood supply, nerve supply (sciatic, femoral nerve), and bone integrity of the knee region. The doctor should also evaluate the remaining amount of bone growth.

• Investigations: Imaging tests like MRI (magnetic resource imaging) and CT (computed tomography) can give the exact location of the tumor and also helps to know about blood circulation.

• Preparation For Artificial Leg: A doctor will make a replica of the patient's original leg before surgical knee amputation so that a temporary leg prosthesis is designed and given to the patient immediately after surgery.

• Pre-Anesthetic Evaluation: The patient is asked questions regarding their health conditions, such as diabetes and blood pressure, and history of previous surgeries. This enables the anesthetist to calculate the dose of anesthesia.

On the Day Of Rotationplasty:

• Anesthesia: A rotationplasty is usually performed under general anesthesia, where the patient falls asleep completely.

• Amputation: If the knee involves the complete removal of cancerous bone along with some amount of the healthy bone, this provides a cancer-free margin which is very important to prevent recurrence. In this process, the complete knee joint and the considered amount of tibia and femur are also removed, and the remaining lower part of the leg is rotated in 180-degree angulation and reattached to the femur of the thigh bone. The reattachment is done with the help of implants and screws.

• Appearance After Surgery: Immediately after surgery, the patient appears to have a short leg with the foot directed backward. The function of the knee joint is compensated by the foot and the ankle.

What Is the Postoperative Surgical Care for Rotationplasty?

• Rotationplasty itself is a time taking procedure. After the surgery, the patient is shifted to the intensive care unit and is kept under observation for about 2 to 3 days. During this period, the blood supply to the foot is closely observed.

• Healing usually takes place within three to six months; if radiotherapy or chemotherapy is suggested after the rotationplasty, the healing process takes a little more time.

• The operated leg is inserted into the cast, and wheelchair assistance or clutches are required for the movement of the patients. This is advised for about 1 or 2 months.

• Once the healing is satisfactory, the patient is suggested for a prosthesis. A prosthesis is customized and designed especially for each and every patient in order to improve functional ability.

Fabrication of the Prosthesis Involves the Following Steps:

• Proper measurement making.

• Casting and molding.

• Prosthetic fabrication.

• Attaching the prosthesis to the patient.

• If required, any adjustments are made.

• And finally, checking the functional ability of the patient.

• Patients can carry out their daily routine functions like walking and running only with the help of a properly fitting prosthesis. Poorly fitted prosthesis could lead to improper functioning.

What Are the Complications of Rotationplasty?

• Arterial Occlusion: It is also known as a reduced blood supply to the peripheral part of the extremities. In the case of rotationplasty, the peripheral part of the leg does not get sufficient blood supply. This leads to ischemia of the leg's peripheral part, leading to serious complications.

• Deep Vein Thrombosis: During the surgery, small blood clots are formed in the veins of the extremities. This is mainly because of the restricted movement after the surgery. These clots block the venous supply and cause pain and swelling of the legs.

• Edema: This is one of the post-surgical complications which leads to the accumulation of fluids in the legs. This is mainly because of the restricted movement post-surgery. So, the patient is advised to perform physical activity like walking as soon as possible after the surgery.

• Bleeding And Infections: Any surgery has short-term complications like bleeding, which can be treated with a blood transfusion. An antibiotic regimen is advised post-surgery to avoid infections.

What Is The Prognosis Of Rotationplasty?

Most of the children perform well after the surgery. This is because their growing bones adapt to the prosthesis very easily and continue to do routine activities like walking and playing.

Elderly people need some time to get adjusted to the usage of prosthetic parts. But the overall prognosis is good in the case of children and adults.

Role of Physiotherapist:

After the prosthetic fixation, patients are advised to perform regular exercises, which are suggested by physiotherapists.

• Exercises are suggested for the stretching and strengthening of the operated leg.

• Ankle, foot, and thigh exercises.

Conclusion

Rotationplasty is an elaborate procedure that is carried out with a multidisciplinary approach. Proper planning, post-operative check-ups, and continuous follow-ups lead to the success of the treatment. Psychological acceptance of the patient's self-image plays a very crucial role in overall treatment.