Saving Lives ... And Limbs -- In-Depth Doctor's Interview

Ivanhoe Broadcast News Transcript with
John Dormans, M.D., Chief of Orthopedic Surgery, Prof. of Orthopedic Surgery,
University of Pennsylvania School of Medicine, Philadelphia,
TOPIC: Saving Lives ... And Limbs

What is rotationplasty?

Dr. Dormans: Rotationplasty is an operative procedure whereby a portion of an extremity is injured or involved with a disease such as cancer. That portion of the limb is removed, and the remaining limb below the involved portion is rotated and reattached, such that the old ankle joint becomes the new knee joint.

What is the benefit of rotationplasty?

Dr. Dormans: Rotationplasty is a procedure that can be used when there are no other good options, primarily indicated in very young children.

Why is it helpful for the children?

Dr. Dormans: Bone cancer tends to affect the most rapidly growing ends of long bones, to the point that it affects the growth plates. If we just take out the cancer and growth plate, reconstructing it with an artificial bone and joint, that child will be looking at a huge leg length discrepancy as they age. Rotationplasty is an option for the very young child with bone cancer because you’re preserving their knee function and leg length discrepancy won’t be a problem for them.

Is rotationplasty an option for children who are done growing?

Dr. Dormans: With older cancer patients we use resection, or removal of the cancer with reconstruction. Resection uses an artificial bone joint and doesn’t need rotationplasty. Rotationplasty is really just indicated for very young children with bone cancer.

Are there many risks involved with the procedure?

Dr. Dormans: The risks with rotationplasty are essentially the same as any other reconstruction for bone cancer operations.

Is rotationplasty as effective as partial amputation?

Dr. Dormans: Actually, rotationplasty is a form of partial amputation. The advantage of rotationplasty is that you preserve the function of the limb. The patients are able to run, walk and function much better compared to a partial amputation.

How does it affect the child aesthetically?

Dr. Dormans: Appearance is the biggest objection we get. The big problem with rotationplasty in that the residual limb looks different than a normal limb but the function is so much better that if the child is looking at a total amputation compared to rotationplasty, rotationplasty is a much better option.

Can you describe what a limb looks like after rotationplasty?

Dr. Dormans: Patients with rotationplasty have a limb that is shorter but the old ankle joint is serving as the new knee joint so they have to wear a prosthesis, or artificial leg. However, instead of having an amputation high above the knee, the level of deficiency is below the knee, so they have an active knee that powers the prosthesis. In other words, they can run and jump. The other advantage to rotationplasty is it will last forever unlike an artificial bone or joint, where those will invariably wear out with time.

How long is the rehabilitation and recovery time?

Dr. Dormans: In any child with a bone cancer there is an extended period of rehabilitation. One of the advantages of rotationplasty is that the rehabilitation is relatively quick, the child can participate in gym and sports and other activities without the fear of loosening or breaking an artificial bone or joint.

The recovery time is a significant amount of time. After rotationplasty is within the realm of six months before the patient is up, walking, and running, and doing very well.

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END OF INTERVIEW

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc., or any medical professional interviewed. Ivanhoe Broadcast News, Inc., assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors in different ways; always consult your physician on medical matters.

If you would like more information, please contact:

The Children's Hospital of Philadelphia
Division of Orthopedics
34th Street and Civic Center Blvd.
Philadelphia, PA 19104
(215) 590-1527
http://www.chop.edu