Van Nes-Borggreve Rotationplasty of the Knee

Abstract

This chapter on rotationplasty according to van Nes-Borggreve outlines the indications, surgical technique, complications and post-operative care of this functionally successful but cosmetically challenging procedure. Although first described for patients with congenital femoral deficiencies, this technique is now primarily used in children and young adults after bone tumour resection about the knee. Rotating the tibia 180° around its longitudinal axis using the ankle joint as a functional knee-replacement above a lower-leg-prosthesis is only advocated in functionally high-demand patients with stable social environments. Although improved knee arthroplasties allowing limb-lengthening have successfully been introduced, rotationplasty should be considered, especially in patients with apparent contra-indications for prosthetic reconstruction. Absolute and relative contra-indications for a rotationplasty are venous and arterial pathology, sciatic nerve dysfunction, impaired ankle extension and expected psychosocial problems. Two different techniques allowing for distal femoral or proximal tibial tumour resections are predominantly used. The first uses the gastrocnemius and tibial muscles to provide normal ankle movement. The later uses the quadriceps and biceps femoris muscles to extend and flex the ankle joint. Major complications such as vascular embolism, wound and bone healing difficulties, although serious, are rare and can be anticipated through extensive pre-operative workup. Even though this technique is surgically and cosmetically challenging, it can offer patients near normal functional rehabilitation and real long-lasting possibilities for work and sports activities.