Rotationplasty

What is rotationplasty?

Rotationplasty is a unique reconstructive surgery to treat bone sarcomas (a rare type of cancer) in a child’s leg or for bone loss around the hip. This surgery preserves the lower leg and provides an opportunity for a better quality of life compared to an amputation higher on the leg.

A rotationplasty removes a section of bone affected by a sarcoma and changes a child’s leg so their ankle joint essentially functions as their knee joint. Surgeons remove their lower leg, rotate it 180 degrees and attach it to a child’s upper leg. Their foot, which is then just below where their knee joint was, can attach to a prosthetic. While this may seem unconventional, this surgery often gives children greater mobility and looks similar to other amputations.

Who should consider rotationplasty?

Rotationplasty is an alternative to other limb salvage surgery options. When kids get this surgery at between 5 to 9 years old their bones will continue to grow, and providers will adjust their prosthetics as needed. This gives kids more time to get comfortable moving with their prosthetic. After a rotationplasty, physical therapy will help them adjust to new walking and running patterns.

Rotationplasty helps kids stay active after surgery. They can do most sports and activities after rotationplasty, but that’s not always true if they have a full leg amputation or certain limb salvage surgeries.

Rotationplasty can be a good option for children if they want to avoid the future revision surgeries that will be necessary with some types of other limb salvage surgeries.

What to expect before rotationplasty

We want your child to be as comfortable as possible before, during and after surgery. In preparation for the procedure, your care team will fully explain the procedure and what to expect following the surgery. They will also connect your child with other children who’ve had this procedure to help create a sense of community and be a resource. Your team may include experts from across the hospital including child life specialists, anesthesiologists, physical therapists and pain management specialists who work together on your child’s unique care plan to ensure a smooth procedure and recovery.

What to expect during rotationplasty

Under general anesthesia, your child will be asleep for the whole procedure. During surgery, a rotationplasty has several phases, including:

• Tumor and bone removal: Our surgeons remove the affected portion of the femur (thigh bone), knee joint and tibia (shin bone), while keeping the blood vessels and nerves intact, maintaining blood supply and feeling in the leg and foot.
• Rotation and bone fixation: We then rotate the lower leg 180 degrees to turn the ankle joint into a knee joint. We then connect the remaining shin bone (tibia) to the remaining thigh bone (femur).
• Reattachment: After our surgeons attach the femur to the tibia, they connect the muscles of the upper leg to the lower leg before joining the skin. While surgical length can vary depending on tumor size and location, a rotationplasty is a complex surgery and takes most of the day to complete.

What to expect after rotationplasty

A rotationplasty is complex surgery, but most children do well after the procedure. After a four to five day stay in our hospital to rest and recover, your care team will help you schedule physical therapy to regain strength and mobility in your child’s leg. Physical therapy doesn’t happen immediately after surgery, but will help your child use a prosthetic later on. Rotationplasty has the potential for less complications and children don’t feel phantom pain that often comes with amputation. This pain comes from nerves that were cut during amputation but rotationplasty maintains those nerves.

Once the leg heals from surgery, your child will meet with a prosthetist, who will make a prosthetic leg. This is a made just for your child. The prosthetists will often come to the hospital for combined visits with your surgeon to ensure the best possible fit and function of the leg. Your child will work with physical therapists to learn to use the new leg.

Long-term, most children who have rotationplasty can have active lives and participate in sports. While it will take a new pattern, walking and running will again become routine for kids after recovery.

If you have any questions or concerns after the procedure, call the ParentSmart Healthline at 1-855-KID-INFO (543-4636). Caring pediatric nurses are available 24 hours a day, 7 days a week to help answer your questions.

Why choose us for rotationplasty

Our Orthopedic Oncology Program specializes in diagnosing and treating both cancerous and non-cancerous bone tumors. Our experienced specialists use the latest surgical technology to provide the best outcomes for your child, including treating 90% of the malignant (cancerous) tumors in our region. And to ensure continued care, we have a specialized, long-term care clinic for orthopedic oncology. Our pediatric oncologists, physical therapists and orthopedic oncologists support you in your post-surgery care.

Rotationplasty is a relatively rare, complex procedure that can give your child the active life they deserve. But you should only trust the most experienced pediatric orthopedic oncology surgery teams with this level of surgery. You’ll find that team at Children’s Hospital Colorado.

Additional resources

Learn more about MIB Agents, a resource for families that supports children with osteosarcoma.