A rotationplasty is a unique form of amputation used to treat bone tumors in children. The procedure removes the malignancy around the knee, and preserves the lower leg, attaching it in reverse to the upper leg so that the ankle joint can serve as a knee joint.
Many people are not aware of the unique benefits of this procedure. However, once the limb is encased in the rotationplasty prosthesis, it looks like any other prosthetic, and rotationplasty offers a much greater range of motion over an above-knee amputation. Rotationplasty patients benefit from a natural gait and those who have undergone the procedure can, in time, run, dance, and jump with ease.
If you’re wondering what life with rotationplasty can look like, check out this video of Gabi Shull, a young cancer survivor. as she demonstrates her successful rotationplasty. She’s even able to dance ballet on pointe, which is an incredible accomplishment.
When is Rotationplasty Considered?
Typically, a rotationplasty is considered only in cases of childhood leg cancer or knee cancer, or for a malignant bone tumor. Since children’s bones keep growing as the child matures, other limb preservation options may not be as viable. Doctors have also found that children did much better than adults when retraining their brain to use their ankle as a knee joint.
In order to perform a rotationplasty, the doctor must be able to save the main nerves of the lower leg, which are key to the success of the surgery. The typical rotationplasty patient is under 12 years of age.
What Are Some Alternatives?
A rotationplasty isn’t always an option for every child diagnosed with malignant bone tumors associated with leg or knee cancer. In the past, doctors have opted for limb salvage surgeries, which involve replacing the diseased area with a combination of grafts and implants. These surgeries can be effective, but leave the limb much weaker. For active children, this can mean leaving behind sports and other physical activities.
The other alternative to a rotationplasty is the complete amputation of the affected limb. This often occurs when cancer has spread into the nerves or blood vessels. The child can be fitted with a prosthesis following the surgery, but will not have the advantage of a functional joint at the knee provided by rotationplasty.
Rehabilitation for Rotationplasty
After a rotationplasty surgery, the patient is sent to the intensive care unit for 1-2 days of close monitoring. After the incision site is fully healed, rehabilitation can begin.
Rehabilitation is often complicated as many patients are weak from chemotherapy and months of inactivity preceding their surgery. During physical therapy and rehabilitation, the child needs to strengthen their ankle, calf, and foot muscles, so they can fully control their prosthesis. Within five years of surgery, the goal is for the patient to be moving freely and independently.
Proper fit and design with rotationplasty are key. The prosthetist needs to understand the anatomical working of the ankle joint as a knee and design sockets that accommodate movement and comfort.
The prosthetic leg will need to be adjusted as the child goes through physical therapy and rehabilitation, and will also need to be customized as they grow. If a prosthesis does not fit well, it can result in poor mobility, irritated skin, and ongoing pain.
A key part of ensuring success following a rotationplasty is picking a good prosthetist. The best ones will listen to your concerns, and work diligently to ensure a perfect fit. Rotationplasty is a rare procedure so not every prosthetist has experience working with rotationplasty patients. Don’t be afraid to call around and speak to them regarding their experience and level of confidence in working with rotationplasty patients before committing.
Live in the U.S. and looking for prosthetists near you? Use our Prosthetist Finder service.
Tips for Dealing with Stigma in Children
Parents with children who have a malignant bone tumor or cancer are in an incredibly tough position. Many people choose a rotationplasty to ensure as much mobility for their child as possible, even if they’re anxious about the unusual appearance of the limb following surgery.
Parents should emphasize the freedom and mobility that this surgery will bring to their child’s life. These procedures are not only life-saving, but they can also offer an increased level of normalcy once the prosthetic is fitted, and the child wants to return to everyday physical activities.
Having children meet other amputees, especially other children and adults who have gone through a rotationplasty, will help them realize that this is a normal procedure.
We also encourage parents to look into our Paddy Rosbach Youth Camp for children aged 10-17 with limb loss or limb difference. This annual, free summer program since has been running since 2000 and provides a fun-filled, inclusive environment.
For advice on your child’s emotional development post-amputation, be sure to also read our related post: Parent’s Guide to Limb Difference and a Child’s Emotional Development
Other Resources on Rotationplasty and Amputation For Children
For a clinical view on Rotationplasty, be sure to read An Explanation of the Rotationplasty and Tibia Turn-Up Procedures.
At Amputee Coalition, our mission is to ensure that no one with limb difference goes through the journey alone. Reach out to us today, and we can connect you with personalized resources related to the rotationplasty procedure and the road to a full and active life.
Featured Photo Credit: Johns Hopkins Medicine