If you have to lose the middle part of your leg, you’ll have two main choices before you: amputate the leg from the middle down, or save the lower part and attach it to the upper part. This is rotationplasty. The “rotation” part comes in because your surgeon rotates the lower part of your leg 180 degrees before reattaching it.
Rotationplasty is a limb salvage procedure that preserves the lower part of your leg after removing the knee. It’s an alternative to amputation above the knee. A surgeon removes the diseased or injured upper part of your leg, then reattaches the lower part (shin, ankle and foot) to your remaining thigh. But they rotate the lower part 180 degrees before reattaching it, so your foot points backward.
Your ankle joint bends backward, which is the opposite way from your knee joint. But after rotationplasty, your ankle becomes your new knee. Your surgeon attaches the lower part of your tibia (shin bone) to the upper part of your femur (thigh bone) to bridge the gap left by the removed part. In this way, the lower tibia replaces the lower femur, and your rotated ankle replaces your knee joint.
This leaves you with a complete and functional upper leg. Then, you can attach a prosthesis (artificial limb) to your new knee joint. The prosthesis on the end, together with the functional knee, allows you to walk and run normally. When you sit down and stand up, your “knees” will be parallel and bend together. And when you wear pants, you might not be able to tell the difference between the two legs.
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Rotationplasty is one option when you need surgery to remove part of your upper leg but want to preserve as much mobility and durability as possible. Bone cancer is the most common reason for this. Cancerous tumors that affect your leg bones, like osteosarcoma and Ewing sarcoma, are more common in children and teens than in adults. This is one reason why children have rotationplasty more often.
Congenital (present at birth) defects are another, less common reason why children have rotationplasty. For example, congenital femoral deficiency (CFD) is an underdeveloped femur. When your entire femur is unusable, your entire tibia can substitute for it, with your knee joint replacing your hip joint. (CFD often appears with another condition called fibular hemimelia, which makes your shin shorter.)
Other reasons for rotationplasty can affect children or adults, but these are rarer. They include:
Children make the best candidates for rotationplasty because their bones are still growing. As they grow, their reconstructed leg grows with them, so they can better adapt it to their activities. Adults don’t have this advantage, but there are still cases where rotationplasty might be their best option.
Rotationplasty is a very uncommon procedure. Very few surgeons have ever performed it, so it’s important to find a medical center experienced with the procedure. It’s complex and challenging for both the surgeon and the person recovering, so both parties should consider the choice very carefully before committing. However, for certain people in certain circumstances, it might be the best choice.
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Rotationplasty surgery requires careful preparation and planning, including:
Rotationplasty includes the following steps:
The surgery itself may take between four and 10 hours to complete. You’ll spend one to two days in the intensive care unit in the hospital (ICU). After that, you’ll spend several more days in a recovery room.
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The main alternatives to rotationplasty are:
The main difference between these and rotationplasty is that they rely on prosthetics or donor bone to replace your knee and leg parts, while rotationplasty uses parts from your own leg. Your nerves and blood vessels stay intact, and the leg continues to grow as you grow, which is especially helpful for children.
Other benefits include:
The main disadvantage of rotationplasty is what your leg would look like, which can take some getting used to. Not everyone feels they could learn to accept the way their leg would look. It’s important to honestly consider this and weigh it against other factors, like how physically limited you’re willing to be.
Risks of surgery include:
Complications during recovery could include:
It may take three to six months for the bones in your leg to fully heal. If you receive chemotherapy for bone cancer after surgery, healing will take longer. You may need a wheelchair or crutches to move around during this time. Once your incision has healed and the swelling has gone down, you’ll be able to start wearing a prosthesis. You’ll learn to use this prosthesis as the lower part of your leg and foot.
Physical therapy is an important part of recovering from rotationplasty. A physical therapist will help you regain strength and flexibility in your hip and ankle joints. They’ll also teach you how to begin using your ankle joint as your new knee joint. This takes practice: You’ll have to retrain your brain and nerves to recognize your new knee and to work together with your prosthesis as your new lower leg.
While adults may take longer than children to adjust to the new leg, most people are able to walk without aid after three to six months. Within six to 12 months, you should be able to return to any activity you wish, including high-impact sports. Many people are pleasantly surprised by how functional their leg is after rotationplasty. The working knee joint gives you mobility you wouldn’t have otherwise.
While rotationplasty is a complex procedure, the surgery doesn’t often fail. Failure might occur if your leg loses blood flow or doesn’t heal well. Cancer treatments like chemotherapy can sometimes interfere with the healing process. This risk is similar with rotationplasty and other limb salvage procedures. Most people recover well from rotationplasty, and they report long-term satisfaction with their results.
A note from Cleveland Clinic
Making a choice like rotationplasty is difficult and might feel very lonely. You’re unlikely to know anyone else who’s faced that choice. But thanks to social media, people living with rotationplasty are much easier to find than they used to be. They’re telling their stories, performing in sports and living their best lives on camera. Spending some time with them could help you get used to the idea of rotationplasty.
Last reviewed on 05/13/2024.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy