Rotationplasty Rehabilitation Protocol: A Complex Case Report

Abstract

Background and Purpose: Rotationplasty is a rare, complex limb salvage surgery that creates opportunity for physical therapists to develop a unique rehabilitation plan focusing on functional mobility and independence. To date, there is no comprehensive rehabilitation-specific protocol documented in the literature for individuals who have undergone rotationplasty. This case report describes the first novel comprehensive rehabilitation protocol, interventional strategies, and optimal functional outcome of a patient who underwent rotationplasty. Case Description: The patient was a 20-year-old man with a history of high-grade osteosarcoma of left distal femur who underwent numerous limb-sparing procedures resulting in pain and debility necessitating rotationplasty. Rehabilitation protocol and focused physical therapy interventions were implemented pre- and postsurgery based on functional limitations. Outcomes: The Toronto Extremity Salvage Score (TESS), Musculoskeletal Tumor Society (MSTS) assessment, Timed Up and Go (TUG) test, range of motion, and strength testing of the affected lower extremity all demonstrated significant improvement from prerotationplasty to postsurgery to 1-year follow-up. A 41.8% improvement in TESS outcome was found from postsurgery to 1-year follow-up. MSTS assessment showed a 60% improvement from presurgery to 1-year follow-up. TUG score improved by 0.7 seconds with no assistive device by final discharge. The patient met all therapy goals and reported no functional limitations at discharge. Discussion: Implementation of a rehabilitation protocol for this unique population guides clinicians' decision making while developing congruency between providers. This protocol paired with targeted interventions promotes successful patient outcome and aids as a framework for clinicians to be used in treating this complex patient population.