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Complications and Risk Factors for Failure of Rotationplasty: Review of 25 Patients

  • Symposium: Selected Papers Presented at the 2007 Meeting of the Musculoskeletal Tumor Society
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Rotationplasty is one treatment option for femoral bone sarcomas in skeletally immature patients. This procedure enables patients to avoid phantom pain, limb length discrepancy, or loosening of an endoprosthesis, and good functional outcome has been reported. However, rotationplasty is only rarely indicated and the surgical complications or risk factors for failure of the procedure that might influence choices of treatment or patient counseling have not been well described. We reviewed 25 patients who underwent rotationplasty focusing on risk factors for failure and postoperative complications. Three of 25 patients had vascular compromise resulting in amputation. All three had vascular anastomosis and were resistant to chemotherapy with less than 95% of tumor necrosis. Two of the three patients who underwent amputation had a pathologic fracture before surgery. Late complications included one patient with a tibial fracture, two with wound complications treated with skin grafts, one with nonunion, and one with subsequent slipped capital femoral epiphysis. Rotationplasty was successfully accomplished in 22 of the 25 patients. Patients with large tumors unresponsive to chemotherapy or preoperative pathologic fracture appear at higher risk for failure of rotationplasty presumably as a result of compromise of venous drainage of the leg.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Andrew E. Rosenberg, MD, and Antonio R. Perez-Atayde, MD, for evaluation of pathologic specimens.

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Authors and Affiliations

  1. Massachusetts General Hospital, Boston, MA, USA

    Chigusa Sawamura MD & Francis J. Hornicek MD, PhD

  2. Children’s Hospital, Boston, MA, USA

    Chigusa Sawamura MD & Mark C. Gebhardt MD

  3. Beth Israel Deaconess Medical Center, Shapiro CC2–330 Brookline Avenue, Boston, MA, 02215, USA

    Mark C. Gebhardt MD

Authors
  1. Chigusa Sawamura MD
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  2. Francis J. Hornicek MD, PhD
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  3. Mark C. Gebhardt MD
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Corresponding author

Correspondence to Mark C. Gebhardt MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Sawamura, C., Hornicek, F.J. & Gebhardt, M.C. Complications and Risk Factors for Failure of Rotationplasty: Review of 25 Patients. Clin Orthop Relat Res 466, 1302–1308 (2008). https://doi.org/10.1007/s11999-008-0231-6

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  • DOI: https://doi.org/10.1007/s11999-008-0231-6

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