Rotationplasty for Malignant Tumors of the Femur and Tibia

Summary

Rotationplasty for malignant tumors of the femur or tibia is a good surgical alternative especially in patients who are still growing. The functional results are excellent; psychological problems due to the rotated limb are amazingly few and minor. Since 1981, I have performed 36 rotationplasties: 14 according to the technique first described by Salzer et al. [2] for distal femur lesions, three for malignant tumors in the proximal or proximomedial part of the tibia, and 19 according to my own technique for malignant lesions in the middle or proximal part of the femur. Seventeen patients had Ewing’s sarcoma, 16 had osteosarcoma, and three had chondrosarcoma. All patients with Ewing’s sarcoma and osteosarcoma received pre- and postoperative chemotherapy. The follow-up time is more than 5 years in four patients, more than 4 years in nine patients, and more than 2 years in 16 patients.

Of the 17 patients with type AI/AII rotationplasties the results were excellent in ten, good in five, fair in one, and poor in one. Of the 16 patients with types BI, BII, or BIII rotationplasties, the results were excellent in nine, good in eight, and fair in two patients. Three patients had superficial wound complications, one patient had a deep infection, one patient had transitory peroneal palsy, and one patient developed a compartment syndrome due to vascular complications and has still almost complete palsy of the sciatic nerve.

Thus far, there has been no local recurrence in any of the patients. One patient (with chondrosarcoma) developed a solitary pulmonary metastasis which was resected. Two patients died of their malignant disease. Rotationplasty should always be discussed with the patient as well as with his or her relatives when planning the treatment of a malignant tumor of the femur or tibia.