Complications and Risk Factors for Failure of Rotationplasty: Review of 25 Patients

Massachusetts General Hospital, Boston, MA, USA.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 07/2008; 466(6):1302-8. DOI: 10.1007/s11999-008-0231-6
Source: PubMed


Rotationplasty is one treatment option for femoral bone sarcomas in skeletally immature patients. This procedure enables patients to avoid phantom pain, limb length discrepancy, or loosening of an endoprosthesis, and good functional outcome has been reported. However, rotationplasty is only rarely indicated and the surgical complications or risk factors for failure of the procedure that might influence choices of treatment or patient counseling have not been well described. We reviewed 25 patients who underwent rotationplasty focusing on risk factors for failure and postoperative complications. Three of 25 patients had vascular compromise resulting in amputation. All three had vascular anastomosis and were resistant to chemotherapy with less than 95% of tumor necrosis. Two of the three patients who underwent amputation had a pathologic fracture before surgery. Late complications included one patient with a tibial fracture, two with wound complications treated with skin grafts, one with nonunion, and one with subsequent slipped capital femoral epiphysis. Rotationplasty was successfully accomplished in 22 of the 25 patients. Patients with large tumors unresponsive to chemotherapy or preoperative pathologic fracture appear at higher risk for failure of rotationplasty presumably as a result of compromise of venous drainage of the leg.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Full-text preview

Available from:
  • [Show abstract] [Hide abstract]
    ABSTRACT: Regrettably amputation remains to the present day an essential part of treatment in osteosarcoma of the limb bones. Only by its inclusion in the therapeutic regime can the present best level of about 20 per cent survival be achieved in any large group of patients. Preliminary biopsy is essential and there is no evidence that it is harmful even if followed by a delay of many days before definitive treatment. In patients treated initially by radiotherapy, selective amputation some 6 months later only in patients free of metastases, carries just as good a prognosis for the group as a whole as initial primary amputation in all patients. This method, first described by Cade, is widely practiced in the United Kingdom and spares many patients who develop early metastases following initial radiotherapy from unnecessary mutilating surgery shortly before inevitable death. Local recurrence may follow retention of a femoral stump following amputation for osteosarcoma at the most common site in the lower femoral metaphysis. There are cogent arguments in favor of hip disarticulation in such patients although they do not include evidence of greater survival. The balance between the two procedures is finely drawn but is weighted in favor of disarticulation.
    No preview · Article · Oct 1975 · Clinical Orthopaedics and Related Research

  • No preview · Article · Jul 2005 · The Journal of Bone and Joint Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: Osteosarcoma and Ewing's sarcoma are the two most common primary malignant bone tumors in children and account for approximately 6% of all childhood malignancies. Treatment methods have seen significant advancements, particularly in regard to chemotherapy and limb-sparing surgery. These advancements have led to increased survival rate. With many long-term survivors, it is important to evaluate long-term patient outcomes following treatment, including function and health-related quality of life. We will review the current trends in treatment of these diseases, different reconstructive options available, and the methods and results for evaluating the long-term results. There have been many improvements in the medical treatment of these tumors leading to increasing long-term survival. There have also been improvements in reconstructive techniques for the maintenance of functional extremities in these patients. Newer evaluation methods for both functional outcome and health-related quality of life measures that are more specific to children and adolescents are being developed and in use. This report will provide an overview of the current treatment options and long-term complications in primary malignant bone tumors for the pediatrician caring for a child with these problems.
    No preview · Article · Jul 2009 · Current opinion in pediatrics
Show more