Rotationplasty - Non Oncologic Applications

Rotationplasty is a surgical procedure used for the treatment of extensive bone and soft tissue loss in the lower extremity, primarily but not exclusively, around the knee joint – most frequently distal thigh or proximal leg. This method utilizes the ankle joint to create a "new knee" after the knee is sacrificed in the intercalary amputation of the involved segment. Its main advantage is the superior functional outcome compared to the more conventional treatment option in these situations - a transfemoral amputation. Rotationplasty is usually used for the reconstruction of bone defects after oncologic resections, and less frequently, to treat congenital femur deformities. This assay uses an example case treated at our institute, to present the possibility of using this technique in other, less described, non-oncologic condition, in this case - trauma.

The case described here, is that of an otherwise healthy adult male, that suffered a crush injury of the left knee. Gustillo Anderson IIIB Open fractures, with bone loss of the distal third of the femur, the proximal tibia, and severe skin and soft tissue loss, including the knee extension mechanism – distal quad muscle, quad tendon, patella, patellar tendon and tibial tuberosity. The distal leg, ankle and foot were unharmed. A resistant polymicrobial infection gradually developed. Advanced dressings, repeated debridements and local soft tissue reconstruction attempts failed, and the option of proximal transfemoral amputation was at stake. As an alternative, the decision was to proceed with rotationplasty.

The clinical course is described here, as well as the pitfalls and advantages of rotationplasty in this scenario. We suggest that rotationplasty, although not commonly used for the treatment of traumatic bone and soft tissue loss or infection, can be a promising treatment option for these situations, and offer obvious advantages compared to trans femoral amputation.