Rotationplasty
Rotationplasty
(e.g. Van Nes Rotation) - The lower leg and foot are rotated 180 degrees, the length is adjusted, and the tibia is then fused to the proximal femur. The foot is positioned where the knee used to be, with the heel portion in front and the toes pointing back. The ankle now functions in place of the knee joint. The primary reason for rotationplasty is to enhance the person's mobility as a prosthesis user. Placing the ankle joint in the position of the knee creates a functional, natural knee, and the toes provide important sensory feedback to the brain. At first glance, both procedures appear somewhat extreme and are difficult for people to visualize. However, the long-term positive results experienced by most patients are impressive. Ideally, rotationplasty gives patients a level of function that may be equivalent to a below-knee prosthesis user, even though they have experienced an above-knee amputation. The appearance of the limb following rotationplasty is very unusual and is a concern for many people from both a cosmetic and a psychological standpoint. Patients and their families who are considering rotationplasty should talk with other people who have had the procedure and are now prosthesis users. For many, the functional advantages quickly outweigh their concerns about appearance. Children and young adults have a lifetime in front of them, and the increased mobility and freedom that may follow rotationplasty can be a significant improvement over the use of a traditional above-knee prosthesis.
The Prosthesis
As with any prosthesis, the fit of the socket is critical. Finding a prosthetist with experience casting a rotationplasty socket may prove challenging. However, with practice, it is no more difficult to cast a rotationplasty socket than any other type of socket. The socket should encase the foot and should have a soft inner liner and an outer layer fabricated from a more rigid plastic. Hinges are placed on both sides of the ankle joint (now positioned as the knee) and then attached to a corset that extends up around the thigh; Velcro straps hold the corset in place.
Hope for Active Lives
When faced with realities such as a severe life altering injury, patients and their families have a hard time just moving from one day to the next. In the midst of anger, grief and loss, they are asked to take part in extremely difficult conversations and make major decisions that will last a lifetime. Consulting with experts provides patients and families with critical information, support and resources. Options like rotationplasty, although unusual, may enable people to live fuller, more active lives as prosthesis users. It is in working together that patients, families, physicians, prosthetists and therapists can create hope for better long-term outcomes.
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