Rotationplasty, also known as Van Nes rotationplasty, is a surgical procedure primarily performed in cases of severe lower limb bone tumors, particularly osteosarcoma, in children. It involves removing the affected portion of the limb, typically the distal femur and proximal tibia, and reattaching the healthy portion of the limb with the foot rotated 180 degrees. This results in the ankle joint functioning as a knee joint, allowing for better function with a prosthetic limb. Here's a detailed description of rotationplasty:

Surgical Technique:

  • Initial Resection: The surgeon performs a wide resection of the affected portion of the limb, typically removing the distal femur, proximal tibia, and tumor-involved soft tissues. The surgeon carefully preserves the neurovascular structures in the remaining portion of the limb.
  • Rotation of the Ankle: The foot and ankle are rotated 180 degrees, so the ankle joint faces backward. The tibia is then reattached to the remaining portion of the femur, creating a new knee joint. The rotated ankle functions as a "knee joint" when a prosthetic limb is attached.
  • Soft Tissue Reconstruction: Soft tissue reconstruction is performed to ensure proper coverage and stability of the newly formed limb. This may involve rearrangement of muscles, tendons, and skin flaps to optimize function and cosmesis.

Prosthetic Fitting and Rehabilitation:

  • Following rotationplasty, the patient undergoes a period of rehabilitation to adapt to the new limb configuration and learn to use a prosthetic limb effectively.
  • A customized prosthetic limb is fitted to the newly formed limb, allowing the patient to walk, run, and engage in various activities with improved function and mobility.
  • Physical therapy and rehabilitation are essential components of the postoperative management, helping the patient regain strength, mobility, and independence.


  • Improved Function: Rotationplasty allows for better functional outcomes compared to above-knee amputation, as the rotated ankle joint can provide greater stability and control with a prosthetic limb.
  • Preservation of Limb Length: Rotationplasty preserves the length of the limb, reducing the need for extensive limb lengthening procedures or adjustments in prosthetic limb length.
  • Psychological Benefits: For many patients, rotationplasty offers psychological benefits by preserving body image, mobility, and independence, compared to traditional amputation techniques.

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