Rotationplasty is a surgery for bone cancer near the knee. A surgeon removes the middle part of your leg, including the tumor. Your lower leg is reattached at your thigh, but rotated 180 degrees. Your ankle joint functions as your new knee joint. You wear a prosthesis, or artificial limb. Rotationplasty is a more functional alternative to an above-the-knee full leg amputation.
Rotationplasty is a surgery to amputate (remove) the middle part of your leg when there is a tumor near your knee. Your surgeon rotates the lower section of your leg (shin bone, ankle and foot) 180 degrees. So, your foot points backwards. They reattach it to your remaining thigh bone. The ankle serves as a replacement knee joint. You wear a prosthesis (artificial limb) on your foot. Generally speaking, a rotationplasty leaves you with greater function than you would have with a standard amputation.
Van Nes rotationplasty is another name for this procedure.
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People with knee tumors from osteosarcoma or Ewing sarcoma (types of bone cancer) may need rotationplasty. The procedure is more common in children and teenagers since osteosarcoma mostly affects this age group.
Children and teenagers are also better candidates for rotationplasty because their bones are still growing. Their reattached leg continues to grow as they grow, so they can adapt to more activities.
In some cases, children and adults with the following conditions may need rotationplasty:
People with the following conditions shouldn’t have rotationplasty:
Rotationplasty isn’t a common procedure. Not many healthcare providers have experience performing rotationplasty. In addition, parents and children may be hesitant to choose rotationplasty because of the uncommon appearance of the foot and ankle.
A rotationplasty requires careful preparation and planning:
Rotationplasty includes the following steps:
After your surgery, you stay in an intensive care unit (ICU) for at least a few days. You might stay in the hospital for up to a week. A team of healthcare providers monitors your leg, foot and toes carefully.
It may take three to six months for the bones in your leg to heal. If you receive chemotherapy for bone cancer after surgery, healing may take longer. You wear a cast on your leg and may need a wheelchair or crutches to move around.
Physical therapy is an important part of recovering from rotationplasty. A physical therapist helps you regain strength and flexibility in your hip and ankle joints. A therapist also shows you how to use your new “knee joint” to perform activities.
Once your leg heals, you start using a prosthesis. It’s important to have a prosthesis that’s specially made for someone recovering from rotationplasty. A poorly fitted prosthesis can lead to complications and mobility problems. As you grow, you will need new prostheses.
Functional results with a well-ﬁtted prosthesis often exceed patient expectations. After three to six months, you'll be able to walk without aid. Most people can return to sports activities, work or attend school within six to 12 months after the procedure.
The biggest risks immediately after surgery include:
Complications that can occur during the healing process or long after surgery may include:
Rotationplasty offers several advantages over other procedures, including:
Most children do well after rotationplasty. Since their bones are still growing, it’s easier for them to adapt to the prosthesis. They’re usually able to return to many activities such as running or playing soccer. Adults may have a longer adjustment period with the prosthesis.
As children grow, they’ll need new prostheses. How often will depend on their rate of growth. They might need to work with a physical therapist each time they get a new prosthesis.
Most people who have rotationplasty don’t need a second surgery unless there are complications. In rare cases, issues like fractures or blood vessel problems may need a full-leg amputation.
A note from Cleveland Clinic
Rotationplasty is a surgery for bone cancer near the knee. A surgeon removes the middle part of your leg, including the knee. They reattach the lower shin, ankle and foot to the remaining thigh bone. They also rotate the lower leg 180 degrees so the ankle joint functions as a knee joint. A prosthesis, or artificial limb, attaches to your foot. People who have rotationplasty usually have much better mobility than people who have a full leg amputation.
Last reviewed by a Cleveland Clinic medical professional on 05/10/2021.
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