Rotationplasty was first described in 1930 by Borggreve for treatment of limb shortening with knee ankylosis after tuberculosis. In 1948, Van Nes described its use for management of congenital defects of the femur and in the 1980s, Kotz and Salzer reported on patients with malignant bone tumors around the knee treated by rotationplasty as an alternative to above-knee amputation. Currently, rotationplasty is one of the options for surgical management of lower extremity bone sarcomas in skeletally immature patients but alternative limb salvage techniques, such as the use of expandable endoprosthesis, are also available. Despite rather satisfactory functional results have been uniformly associated with rotationplasty, concern still exists about the potential psychological impact of the new body imagerelated to the strange appearance of the rotated limb. Results of rotationplasty for sarcomas of the distal femur over a 20-year period were analyzed, focusing on long-term survival, function, quality of life and mental health. Retrospective study of 73 children who had a rotationplasty performed at two institutions between 1984 and 2007 for a bone sarcoma of the distal femur; 42 males and 31 females, mean age at surgery 8.7 yrs (range 3–17). Four patients were converted to transfemoral amputation due to early vascular complication; 25 eventually died of their disease (mean survival 34 months, range 4–127). The 46 remaining survivors were evaluated for updated clinical outcome, MSTS score, gait analysis, SF-36 score, quality of life interview and psychological assessment at mean follow-up of 15 yrs (range 3–23).Purpose
Method
Rotationplasty, or the Van Nes procedure, is a surgical option for reconstruction of the lower extremity after resection of a malignant bone tumor in predominantly skeletally immature patients. The procedure usually involves resection of the femur and knee joint en bloc. Virtually all soft tissues, including skin around the tumor, are excised, and the sciatic nerve is preserved. The vessels can be resected and re-anastamosed or preserved. The leg and foot are rotated 180 degrees and reattached, preserving and/or restoring the nerves and blood supply. The foot and ankle which face posteriorly, then function as a knee joint in a custom-made prosthesis. Although this procedure has been successfully performed for many years, patients and families cite cosmesis as a major consideration when making this decision. The lack of knowledge and understanding of the functionality, the psychosocial adjustment, and the quality of life with the rotationplasty, also, present challenges for families with respect to acceptance of this surgical choice. Two case studies will be discussed to demonstrate the biopsychosocial elements of this procedure. These two individuals, 2.5 years and 24 years post-rotationplasty respectively, have attained success in their personal and professional lives, and they have willingly and enthusiastically shared their experiences with patients and families considering this surgical option. Using Roy’s adaptation model, this presentation will focus on adopting positive role modeling to enhance adaptive strategies needed by patients and families to guide their decision making.
