One of the most interesting surgical techniques I’ve read about recently is a rotationplasty. Surprisingly, it has been a well-known option since around 1950 that is usually performed on cancer victims, especially children, with osteosarcoma or limb-threatening infections around the knee. It is fascinating to see how using this method allows an individual who loses part of their leg to still function somewhat normal with the use of a prosthesis.

In the following article, Medical News Today highlights this procedure:

Five weird and wonderful surgical procedures – Medical News Today

In this article, we take a look at five of the most bizarre and incredible surgical procedures to date.

1) Rotationplasty: Turning an ankle into a knee

Surgical Team

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Rotationplasty is an extraordinary form of reconstructive surgery that enables the ankle to be used as a knee joint.

The procedure involves the surgical removal of the bottom of the femur, the knee, and the upper tibia. The lower part of the leg is then rotated 180 degrees and attached to the thigh.

Put simply, the foot is attached to the knee backward. Once a prosthesis is fitted, the ankle of the foot functions as a knee.

Rotationplasty is most commonly performed in children who have malignant bone tumors – such as osteosarcoma or Ewing sarcoma – near the knee that have not responded to other treatments.

The main aim of rotationplasty is to fully remove the tumor, but in a way that allows a child to have an active lifestyle, which would not be possible with complete amputation.

Read the rest of the surgical procedures here:  Five weird and wonderful surgical procedures – Medical News Today

This young lady had a rotationplasty as a child. Even though it is sad that she went through all she did, she has a great attitude and is able to lead an active life. Being fitted properly for the prosthesis and learning to use it is critical in the success of the overall process. The video is from the Mayo Clinic and does a good job of explaining how a rotationplasty works and the impact it can have on the patient:

This next story is about Stephen Miller who as a young boy who went through the rotationplasty surgery. After having a poorly fitting prosthesis that gave him blisters, his parents carefully chose a prosthetist who had experience in dealing with that type of fitting. The result was profound for Stephen who went on to become Certified Prosthetist Orthotist (CPO) and regional vice president of Hanger Clinic, Savannah, Georgia. He, in turn, has helped many others be fitted with a good prosthesis and lead a normal, active life:

Prosthetic Management of Rotationplasty in Children | April 2016 | The O&P EDGE | oandp.com

His parents soon found a prosthetist who had experience with the procedure and the result was immediate, Miller says. I tell you, he made me a prosthesis and from that day on I knew the importance of a good-fitting prosthesis and how it can change your life, he says. I played every sport, hiked, water skied, and snow skied. The only difference between me and my peers was that I couldn’t run as fast.

The difference in his life was so profound, he says, that it inspired him to become a prosthetist and help other children with the procedure. Since rotationplasty is rare, and still relatively new, there aren’t a lot of prosthetists with experience fitting these patients. Some who attempt it, he says, don’t always do their due diligence before they attempt to fit a patient.

Medical Symbol

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I’ve seen some terribly designed prostheses and those parents think that they made a mistake [with the surgery], Miller says. [The parents] chose a prosthetist who was recommended to them, and because they are good prosthetists they think they can do the rotationplasty, but they don’t really know what they are doing.

Left untreated, a bad fit can lead to pain and other complications. One of the most common, he says, is verrucous hyperplasia thick, raised, and itchy tissue over the patient’s toes. This is usually because the prosthetist does not know how to protect and fit the toes within the prosthesis.

Many times, problems last longer than they should because children, who make up the majority of rotationplasty patients, are less likely to complain and more likely to push through the pain than adults would, he says.

Read the full post here:  Prosthetic Management of Rotationplasty in Children | April 2016 | The O&P EDGE | oandp.com

Understanding the anatomy of the ankle is the key with a properly fitted prosthesis. Allowing for the toes as part of the picture is much different from the way a normal prosthetic apparatus is made. Also, the ankle isn’t a very stable joint, so it needs to be supported appropriately. The surgery is somewhat rare, so there aren’t a lot of statistics on its success, but the people I read about who have had a rotationplasty surgery are very pleased as opposed to the alternative because they are able to control the movement of the prosthesis much better.