Rotationplasty is a unique limb-salvage procedure where, after tumour resection around the knee, the lower leg is rotated 180 degrees and reattached so that the ankle functions as a new knee joint — providing excellent prosthetic function for growing children.
The tumour-bearing segment (typically the distal femur and knee joint) is resected. The lower leg is rotated 180 degrees on its vascular pedicle (the blood vessels are preserved) and reattached to the remaining proximal femur. The ankle joint, now facing backwards, functions as a biological knee joint within a below-knee prosthesis. The foot acts as a weight-bearing stump. The operation takes four to six hours.
Rotationplasty is primarily offered to growing children with tumours around the knee where endoprosthetic reconstruction would require multiple revision operations as they grow. The rotationplasty provides a biological joint that grows with the child and allows high-level physical activity.
Expandable endoprosthetic reconstruction (requires multiple lengthening procedures), above-knee amputation, or limb salvage with conventional reconstruction.
Specialist sarcoma centre. Full staging. MDT discussion. Extensive psychological preparation — the appearance of the rotated foot is initially striking, and careful counselling is essential.
Excellent functional outcome — the ankle joint provides active 'knee' flexion and extension. Children achieve high levels of physical activity, including running and sports. The biological joint grows with the child, avoiding the need for multiple revision surgeries. Energy expenditure during walking is much lower than above-knee amputation.
The appearance of the rotated foot takes time to accept. Comprehensive psychological support is essential.
The rotated limb may grow at a different rate, requiring shoe modifications.
Unusual sensations in the rotated limb.
The blood supply to the rotated limb may be compromised. Close post-operative monitoring is essential.
The bone junction may fail to heal.
Sciatic or peroneal nerve injury.
From the extensive surgery.
Of the tumour.
General anaesthesia. Major surgery with significant blood loss. Prolonged operating time.
Hospital stay one to two weeks. Close vascular monitoring for 48 hours. Prosthetic fitting at six to eight weeks once healing is confirmed. Gait training with the below-knee prosthesis. Most children achieve excellent walking and running within six to twelve months. Long-term follow-up for oncological surveillance and prosthetic needs.
Intensive early monitoring. Oncological surveillance. Regular prosthetic reviews. Psychological support throughout.
By rotating the lower leg 180 degrees, the ankle joint becomes a biological 'knee' joint. This provides active flexion and extension within a below-knee prosthesis, giving far better function than an above-knee amputation. The ankle is a robust joint that grows with the child.
Most children and families adapt well with appropriate psychological support. The functional benefits — running, jumping, and sporting activity — are transformative. Many children with rotationplasty participate in competitive sports.
Expandable endoprostheses require multiple surgical lengthening procedures as the child grows (every six to twelve months), each carrying risks of infection and mechanical failure. Rotationplasty provides a biological, growing joint that avoids this burden.