Definition and Overview

Rotationplasty is a rare surgical procedure that involves removing tumors in the leg and rotating the feet and ankle 180 degrees to serve as the new knee joint. Also called Van-Nes rotation (named after the doctor who pioneered the procedure), it is often performed to improve mobility following an amputation.

The procedure, which is known for its high success rate, is a type of autograft procedure since the limb used belongs to the same person. However, while autograft is not new, Van-Nes is not commonly performed, and there are criteria that have to be strictly met before it can be explored.

Who Should Undergo and Expected Results

Rotationplasty is usually done on patients who are diagnosed with bone cancer (osteosarcoma), particularly on the distal femur (or the end of the thighbone that is closest to the knee joint). Although it can be performed on patients of all ages, it is mostly done on children and teens as they are more prone to developing osteosarcoma. And because the patients’ bones have more time to grow and mature, the success rate of the procedure is very high. However, it is important to note that rotationplasty does not cure bone cancer but is an effective method of preventing the disease from spreading to other parts of the body.

How Does the Procedure Work?

Rotationplasty or Van-Nes rotation is a long and complex procedure that can take as much as 10 hours to complete. It requires general anaesthesia and intensive care unit admission for at least 24 to 48 hours.

During the procedure, the tumor is dissected along with a part of the tibia (shin bone) and the femur. Extra tissues will also be taken to determine if cancer has already spread to other parts of the body. The rest of the leg is then attached to the remaining femur bone with the ankle and feet rotated 180 degrees. This way, the ankle can work in the opposite direction and function like the knee joint. Metal screws and plates are placed to help the bone heal.

Possible Complications and Risks

One of the short-term complications of the procedure is an infection, which may result from the lack of blood supply circulating in the remaining limbs.

In the long term, Van-Nes rotation may introduce unequal bone length, which means the child may have to undergo more surgeries. Thus, surgeons need to plan ahead for future bone growth, which may include removing the growth plates of the knees and creating a residual limb when and as needed.

Also, the patient may experience a slow healing process if he undergoes other cancer treatments including chemotherapy and radiation therapy.

Further, even if the procedure successfully helps patients transition to using a functional prosthesis, patients will still require intensive physical therapy, several prostheses changes, and counseling to help deal with the physical changes brought about by their condition.

References:

  • Sawamura C., Matsumoto S., Shimoji T., et al. Indications for and surgical complications of rotationplasty. Journal of Orthopaedic Science. 2012;17:775–781. doi: 10.1007/s00776-012-0278-9

  • Gottsauner-Wolf F., Kotz R., Knahr K., Kristen H., Ritschl P., Salzer M. Rotationplasty for limb salvage in the treatment of malignant tumors at the knee. The Journal of Bone & Joint Surgery Series A.1991;73(9):1365–1375

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