Clinical Orthopaedics and Related Research

, Volume 466, Issue 6, pp 1302–1308 | Cite as

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

  • Chigusa Sawamura
  • Francis J. Hornicek
  • Mark C. Gebhardt
Symposium: Selected Papers Presented at the 2007 Meeting of the Musculoskeletal Tumor Society

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.

Notes

Acknowledgments

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

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Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Chigusa Sawamura
    • 1
    • 2
  • Francis J. Hornicek
    • 1
  • Mark C. Gebhardt
    • 2
    • 3
  1. 1.Massachusetts General HospitalBostonUSA
  2. 2.Children’s HospitalBostonUSA
  3. 3.Beth Israel Deaconess Medical CenterBostonUSA

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