Rotationplasty Salvage Procedure as an Effective Alternative to Femoral Amputation in an Adult With a History of Osteosarcoma: A Case Report and Review.

Jean Gaillard,Vincent Crenn,Dominique Eveno,Alban Fouasson-Chailloux,Guillaume Bokobza,Romain Heidar,François Gouin,Marie Pouedras,Marta Da Costa,Christophe Nich

doi:10.3389/fsurg.2021.820019

Abstract

Rotationplasty or Borggreve-Van Ness surgery is lower limb salvage surgery, indicated mainly in the management of femoral bone sarcoma and congenital femur malformations in children. It can also be an interesting surgery option for managing chronic osteoarticular infections, or in cases of non union when curative therapy is no longer an option, as an alternative to femoral amputation. The principle of this surgery is to remove the affected knee and to apply a rotation of 180° to the distal part of the lower limb in order to give the ankle the function of a neo-knee. With the help of an adapted prosthesis, the aim is to allow patients to resume their social and professional activities by keeping most of their lower limb, thus avoiding the known complications of amputation (ghost limb pain, proprioceptive deficit, psychological disorders). Nevertheless, this surgery is complex and exceptional, with vascular, infectious, and psychological risks - the chimeric aspect of the lower limb may cause significant ill-being for the patient. This article reports the case of a 38-year-old patient consulting for management of a complex septic distal femoral non-union following osteosarcoma considered as being in remission. The patient underwent rotationplasty surgery on his left lower limb, with very good functional results and no surgical revision to date. In light of this particular case, we propose a didactic overview of the literature data concerning this surgery, especially in adulthood.

Highlights

The principles of rotationplasty surgery were first described by Borggreve at the beginning of the 20th century, as a means of managing the osteoarticular complications of tuberculosis [1]
This article presented a rare case of rotationplasty of the lower limb, performed in an adult, at a therapeutic dead end with non union of the lower extremity of the femur secondary to management of osteosarcoma
We propose a review of the key points regarding rotationplasty surgery strategy in light of our patient’s case management

Summary

Introduction

The principles of rotationplasty surgery were first described by Borggreve at the beginning of the 20th century, as a means of managing the osteoarticular complications of tuberculosis (knee ankylosis, limb shortenings) [1]. The role of rotationplasty in children may be reassessed because of progress in bioengineering, with the emerging role of growing prosthetic designs for skeletally immature patients [7, 8]. This surgery remains widely performed in growing children to manage congenital limb malformations (allowing preservation of the growth potential of the limb) [6] and distal tumors of the femur (osteosarcoma, Ewing sarcoma) [9]

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