Rotationplasty

• Tumours involving both distal femur and proximal tibia in children and young adults.
• Cases with extensive soft-tissue involvement precluding megaprosthesis.
• Patients seeking durable, high-function reconstruction without major revisions.

1. Tumour resection: en bloc removal of the affected femur segment and knee joint.
2. Rotation: the distal limb (lower leg and foot) is rotated 180° so the ankle functions as a knee.
3. Reattachment: the tibia is fixed to the proximal femur with a plate and screws.
4. Prosthesis fitting: a custom external prosthetic limb attaches to the rotated ankle "knee".

• Gait and endurance comparable to above-knee amputees — with 14% lower mean oxygen cost.
• 60% return to non-contact sports; 30% to competitive athletics.
• MSTS scores average 85–90%.
• Once performed, rarely requires revision — 20-year implant survival is essentially indefinite as there is no internal prosthesis.

• Growth accommodation: the biologic ankle-knee grows naturally, avoiding leg-length discrepancy.
• Durability: avoids multiple revision surgeries over decades.
• Function: superior muscle strength and proprioception in younger patients.

• Cosmetic appearance: the reversed ankle is visible without the prosthesis; under the prosthesis the appearance is normal.
• Psychosocial impact: Indian families often hesitate initially due to stigma — acceptance is high once function is experienced.
• Wound infection ~10%, vascular compromise < 5%, nerve injury < 3% — all manageable with expert care.
• Socket fitting and alignment require professional prosthetics; long-term stability is excellent.

The decision is shared. We combine a multidisciplinary evaluation (tumour biology, age, activity goals, psychosocial factors), a trial limb simulator so patients can experience gait beforehand, and connection with rotationplasty patients to build realistic expectations.

Arjun was diagnosed with osteosarcoma of his distal femur. After meeting our team, trialling a limb simulator, and discussing it as a family, he chose rotationplasty. Treatment included neoadjuvant chemotherapy, the Van Ness procedure and a customised prosthetic fitting. Within three months he returned to school and captained his basketball team — citing "better strength than before". At five years post-surgery, he remains disease-free with no revision surgery and full sports participation.

Rotationplasty is a proven, durable limb-salvage option for children and young adults with large bone sarcomas. Despite cosmetic stigma in some cultural contexts, peer support, modern prosthetic coverage and the superior lifelong quality of life make it a compelling choice.