Facilitating rotationplasty.

Rotationplasty, a unique surgical procedure where the ankle is converted into the knee joint after shortening and 180 degree external rotation of the limb is a well accepted alternative to amputation in musculoskeletal oncology. The required vascular dissection can be quite difficult as the concerned vessels lie in the posterior compartment from the distal third of the thigh downwards. The problem is compounded when rotationplasty is used as a salvage procedure after failed limb-sparing tumor surgery because of the additional fibrosis and stiffness at the level of the prosthetic knee joint. We advocate making the femoral osteotomy at an early stage in the procedure so as to allow free rotation of the distal limb thus making the popliteal fossa and the limb distal to it face anteriorly to facilitate the neuro vascular dissection. We also describe use of a novel cutting jig to ensure a perfect horizontal cut perpendicular to the long axis of the bone while making the femoral and tibial osteotomies. This ensures maximal surface contact between the apposing femoral and tibial cut ends, promoting early bony union. (c) 2007 Wiley-Liss, Inc.