Rotationplasty for Children
Children who are diagnosed with osteosarcoma or Ewing’s sarcoma in their distal femur usually have three surgical options. Physicians may recommend a procedure such as a limb removal or partial limb removal when it’s no longer possible to save the limb due to the spread of the cancer. Another way that this is accomplished is through Van Nes rotationplasty.
An osteosarcoma is a cancerous tumor in a bone. It is the most common histological form of primary bone cancer, and is most often found in teens and young adults. It occurs most often in the wide ends of long bones, such as the femur and tibia, as well as the humerus. Osteosarcoma occurs most often in children and young adults, usually after age 10..
Ewing's sarcoma is a small, round, blue malignant cell tumor. This rare disease is caused by cancer cells in the soft tissue or bone. It is most commonly found in the pelvis, femur, humerus, ribs, and clavicle. This disease is more common in males, and usually presents in childhood or early adulthood.
Van Nes Rotationplasty
Van nes rotationplasty allows for the removal of the affected part of the limb as well as the joint. Above the bone tumor is removed, the distal limb is then attached back to the proximal limb with the foot facing backward - the ankle and heel becoming the new knee joint.
Rotationplasty is most often advocated for young patients who suffer from bone cancer in their distal femur (the lower end of the thigh bone), though it has also been used for older patients on occasion. To remove the distal femoral tumors, the section of bone affected by the cancer must be removed. Rotationplasty is a reconstructive surgical option. Other common surgical options include amputation or metal joint reconstruction.
A prosthesis can then be attached to the foot, allowing the patient to better control movement of their prosthetic limb. In children, there will be frequent prosthesis changes as their limbs grow.
The surgical procedure can take anywhere from 6 to 10 hours to complete. Generally, the distal limb (often the ankle joint) is rotated 180º, the length is adjusted, and the tibia is fused to the proximal femur to become the knee joint. The remaining limb is rotated since the ankle flex occurs in the opposite direction of the knee. This procedure allows the patient to have a functioning knee joint, granting them the ability to run and jump.
When considering whether a child should undergo rotationplasty, the physician takes many factors into account. These include the age and size of the child, the size and location of the cancer, and the functional outcomes desired and the patient wishes.
According to the Amputee Coalition website, “Before having an above-knee amputation or a surgical fusion of the knee, patients should learn about the Van Nes rotationplasty and the tibia turn-up, two surgical procedures that may increase their mobility as prosthesis users. At first glance, both procedures appear somewhat extreme and are difficult for people to visualize. However, the long-term positive results experienced by most patients are impressive.”
Recovery is an ongoing process, and varies from person to person. There are several phases on the road to recovery, and each can hold difficult challenges and require different coping strategies. Many people feel that talking with friends and family (or a counselor) can help ease emotional distress.
Working closely with patients and caregivers in Kentucky and Indiana, the Kenney Orthopedics Team employs the latest biomechanical management, materials, and technology to restore function and permit normal motion after your amputation.
The highly qualified staff of Kenney Orthopedics will select, design, and fabricate the appropriate prostheses, prosthetic limb or device, or orthosis to fit your specific lifestyle and needs after your amputation. Visit us in Louisville or Lexington Kentucky, or at one of our other locations in Kentucky (KY) or Indiana (IN). We can help you get moving again with a prosthesis designed for you after your amputation!
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