Abstract
A rotationplasty is a unique surgical procedure used to reconstruct after resection of a tumor of the leg or a congenital defect. This procedure avoids phantom pain, limb length discrepancy and infections or implant related complications. The outcome is unusual for cosmesis but very functional.
Background: Borggreve first described a rotationplasty in Germany in 1930 for a 12 year old patient whose knee was destroyed by tuberculosis. In 1950 Van Nes modified the procedure. Kotz and Saltzer described in 1982 the use of a modified version of a rotationplasty to treat malignant tumors of the distal femur.
Case studies of two such patients will be presented.
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A 27 year old man had a non-metastic osteosarcoma of his distal femur at the age of five. He underwent chemotherapy and a rotationplasty. Six years after his operation a correction osteotomy was done. He is doing very well physically and mentally. He graduated business studies, went yearly on Alpine skiing on two legs, likes jogging and perceives no limitations in his life (MSTS, TESS, SF-36).
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A 24 year old man, 14 years after a Ewing-sarcoma of his hip. He underwent chemotherapy and radiation therapy. Thirteen years later he had a pathological fracture after playing soccer. He was treated with a total hip prosthesis without screening the malignancy. However the pathology of the specimen showed a postradiation sarcoma. He underwent a modified Van Nes rotationplasty (knee for hip and ankle for knee).
Although is said that rotationplasty had a poor cosmesis and poor psychosocial acceptance, this is not our experience.
Correspondence should be addressed to Professor Stefan Bielack, Olgahospital, Klinikum Stuttgart, Bismarkstrasse 8, D-70176 Stuttgart, Germany. Email: s.bielack@klinikum_stuttgart.de
