Have you ever heard of a surgery where part of a person's leg is removed and the remaining lower part is rotated 180 degrees and then reattached? It may sound a little strange. But this is a very important medical procedure that fights serious conditions, especially bone cancer in the leg, and brings new hope to the lives of young children, especially. Today, we will talk about this special surgery called Rotationplasty.
Simply put, what is Rotationplasty?
Rotationplasty is a special surgery that is performed to save a person's leg (limb salvage procedure). Imagine that a person has a medical condition such as cancer in the knee and the surrounding area. Usually, the entire leg is amputated above the knee. But in Rotationplasty, something different is done.
The surgeon first removes the part of the leg that has the disease (usually the lower thigh, knee, and upper leg). Then, the remaining lower leg, which is your ankle, foot, and ankle , is taken and rotated 180 degrees. It is then reattached to the remaining upper thigh.
Now you may be wondering, "Why are you turning this back?"
Think about it. Your knee bends forward. But your ankle bends backward. After this surgery, your ankle acts as your new knee. That is, when you turn it back, your ankle can bend forward just like a knee. Once your leg is fixed in this way, you can attach a prosthetic leg to it. Then, the "new knee" made from your own ankle and the prosthetic leg will work together, allowing you to walk, run, and even jump normally.
Surprisingly, when you wear pants, you may not even notice the difference between your legs. When you sit down or stand up, both "knees" are bent parallel to each other.
Who is performing this surgery?
This is not a surgery for everyone. This is a very rare surgery. This surgery is mainly considered in the following situations:
- Bone Cancer: This is the main reason. When bone cancers such as `Osteosarcoma` and `Ewing sarcoma`, which are especially common in children and young people, occur around the knee, this method is used to completely remove the cancer cells. Since children's bones are still growing , their legs grow with their bodies after the surgery. Therefore, it is very easy for them to adjust to this.
- Congenital Defects: Some children may be born with a condition where the femur (thigh bone) does not develop properly (Congenital Femoral Deficiency - CFD). In such cases, Rotationplasty is also considered.
- Other reasons: Rarely, this surgery can also be performed for things like serious accidents and incurable infections.
How do you prepare before surgery?
Since this is a big decision, there are many things to consider before the surgery.
1. Be well informed: You and your family should have a clear understanding of how your leg will look after surgery, the healing time, and physical therapy. Your doctor will explain this to you thoroughly, and if necessary, even show you photos or videos of people who have had this surgery. It is very important to prepare yourself mentally for this.
2. Physical examination: The doctor will check whether you have good range of motion in your hip and ankle. He will also check whether the main nerve that goes to your leg, the sciatic nerve, is functioning properly. This nerve is essential for the surgery to be successful.
3. Imaging tests: Before surgery, the surgical team performs tests such as X-rays, MRIs, or CT scans to thoroughly study the condition of the inside of the leg and how the cancer has spread.
4. Preparation for the prosthesis: Sometimes, your foot will be measured before surgery and a temporary prosthesis (prosthesis) will be made that can be used immediately after surgery.
The difference between Rotationplasty surgery and other options
There are two main options one can choose instead of Rotationplasty:
- Amputation of the leg above the knee and the use of a suitable artificial limb.
- Removing the cancerous part and replacing it with metal parts or a bone graft from someone else.
Let's look at the advantages and disadvantages of Rotationplasty surgery when compared to these two methods in this table.
| Feature | Advantages of Rotationplasty | Disadvantages and risks |
|---|---|---|
| Functionality | Because their own ankles act as knees, movement and control are very high. They can run, jump, and even play sports. | Training is needed to get the brain and nerves used to the "new knee." |
| Durability | Because it uses your own tissue, nerves, and blood vessels, it is more durable and less likely to require additional surgeries. | There is a risk of delayed union during healing. |
| Appearance | Although it doesn't make a difference when wearing pants, this is something that was done to increase functionality. | This is the main disadvantage. The leg is turned back, so the appearance is different. It takes time to mentally accept it. |
| Complications | Complications such as ``phantom limb pain'' (feeling like the missing leg hurts) that occur when a leg is amputated are avoided. | The surgery is very complex. There are risks of ischemia, nerve damage, and infection. |
How is the recovery time?
This is a major surgery, so it will take time to heal.
- It can take about 3 to 6 months for the two bones to heal completely. If you are undergoing cancer treatment like `Chemotherapy`, it will take a little longer to heal.
- During this time, you will have to use a wheelchair or crutches.
- Once the scar has healed and the swelling has subsided, the prosthesis can be worn.
- Physical therapy is a very important part of this journey. A physical therapist will teach you exercises to strengthen and flex your hip and "new knee" (ankle). This is where your brain gets used to this new movement.
Children adapt to this more quickly than adults. But within 6-12 months, most begin to walk without any support. They reach the point where they can engage in any activity, even sports, they like.
Making a decision like Rotationplasty can be a very difficult and lonely one. Because someone you know could have gone through something like this and lost it. But today, with social media, you have the opportunity to find people who have had this surgery, hear their stories, see how they play sports, and live normal lives. Seeing things like that can be a great strength in making this decision.
Take-Home Message
- Rotationplasty is a rare but successful surgery to save a leg. It is a good option, especially for bone cancer in children.
- This turns the patient's own ankle into a functional knee, providing greater mobility and function.
- The main thing to consider is the change in the appearance of the leg after surgery, but the functional benefits are very high.
- This is a very personal and difficult decision, so it is essential to have a thorough discussion with your doctor about all the pros, cons, and risks before deciding to have the surgery.
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