Long-term follow-up of Van Nes rotationplasty in patients with congenital proximal focal femoral deficiency

Ackman, Jeffrey D.; Altıok, Haluk; Flanagan, Ann; Peer, Mary; Graf, Adam; Krzak, Joseph J.; Hassani, Sahar; Eastwood, Dan; Harris, Gerald F.

doi:10.1302/0301-620x.95b2.30853

Cited by 47 publications

(43 citation statements)

References 29 publications

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“…In unilateral cases with a predicted limb discrepancy of less than 20 cm, lengthening procedures may be indicated (Fig 10) (9). Otherwise, when the predicted limb discrepancy is greater than 20 cm, different treatment choices are directed to prosthetic fitting, including knee arthrodesis (with the meta-epiphyseal synostosis of one or two of the knee growth plates), amputation of the foot (usually associated with the knee arthrodesis) (Fig 11), or Van Nes rotationplasty (the limb is rotated 180°, with or without knee arthrodesis, and the ankle joint resembles the knee joint within a prosthesis) (9,32). Some patients with knee instability can benefit from hip stabilization and correction of the varus deformity, pseudarthrosis, and anteversion defect (9,27).…”

Section: Surgical Management Of Pffdmentioning

confidence: 99%

Common Patterns of Congenital Lower Extremity Shortening: Diagnosis, Classification, and Follow-up

Bedoya¹,

Chauvin²,

Jaramillo

et al. 2015

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Congenital lower limb shortening is a group of relatively rare, heterogeneous disorders. Proximal focal femoral deficiency (PFFD) and fibular hemimelia (FH) are the most common pathologic entities in this disease spectrum. PFFD is characterized by variable degrees of shortening or absence of the femoral head, with associated dysplasia of the acetabulum and femoral shaft. FH ranges from mild hypoplasia to complete absence of the fibula with variable shortening of the tibia. The development of the lower limb requires complex and precise gene interactions. Although the etiologies of PFFD and FH remain unknown, there is a strong association between the two disorders. Associated congenital defects in the lower extremity are found in more than 50% of patients with PFFD, ipsilateral FH being the most common. FH also has a strong association with shortening and bowing of the tibia and with foot deformities such as absence of the lateral rays of the foot. Early diagnosis and radiologic classification of these abnormalities are imperative for appropriate management and surgical planning. Plain radiography remains the main diagnostic imaging modality for both PFFD and FH, and appropriate description of the osseous abnormalities seen on radiographs allows accurate classification, prognostic evaluation, and surgical planning. Minor malformations may commonly be misdiagnosed.

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Section: Surgical Management Of Pffdmentioning

confidence: 99%

Common Patterns of Congenital Lower Extremity Shortening: Diagnosis, Classification, and Follow-up

Bedoya¹,

Chauvin²,

Jaramillo

et al. 2015

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“…Treatment for patients with mild congenital femoral deficiency (Paley Type 1a and 1b) generally has involved lengthening of the shortened extremity, whereas treatment for patients with moderate congenital femoral deficiency (Paley Type 2a) has been knee fusion and prosthetic fitting, rotationplasty, Syme amputation, or ablative treatment [1,11,13,15,20,41,44,46]. Recently, advances in treating moderate congenital femoral deficiency by lengthening have allowed preservation of a functional limb while attempting to lessen the psychosocial burden on the patient [4,31].…”

Section: Introductionmentioning

confidence: 99%

Lengthening With External Fixation Is Effective in Congenital Femoral Deficiency

Prince

Herzenberg

Standard

et al. 2015

Clin Orthop Relat Res

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Background Treatment of congenital femoral deficiency is a complex, multistage protocol and a variety of strategies have been devised to address joint instability, limb length inequality, and deformities. Despite being an important part of the algorithmic approach to the overall treatment of patients with congenital femoral deficiency, a reproducible, safe, and functional treatment for femoral length discrepancy in patients with mild and moderate congenital femoral deficiency has not been reported. Questions/purposes (1) Does femoral lengthening by means of distraction osteogenesis, using a monolateral external fixator, result in effective lengthening without loss of hip or knee range of motion? (2) Does femoral lengthening cause an inhibition of femoral growth in patients with congenital femoral deficiency? (3) Do patients/families report satisfactory functional and emotional outcomes after undergoing femoral lengthening? (4) (Schaumburg, IL, USA), Pega Medical, and Springer (New York, NY, USA) outside the submitted work. The institution of one or more of the authors (JEH, SCS, DP) has received, during the study period, funding from Smith & Nephew, DePuy Synthes, Orthofix, Biomet, and OrthoPediatrics. One or more of the authors certifies that he (SCS), or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount less than USD 10,000 from Smith & Nephew, an amount less than USD 10,000 from Ellipse Technologies, and an amount less than USD 10,000 from Orthofix. One or more of the authors certifies that he (DP), or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Orthofix, Inc during the period of this study. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution 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. 123Clin Orthop Relat Res (2015) 473:3261-3271 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® 1a, 1b, or 2a that had not previously undergone lengthening and had stable hip and knee joints. Of the 32 patients that completed treatment, 30 (94%) were available at a minimum of 2 years (mean, 3 years; range, 2-4.5 years) and were evaluated in this retrospective study. Preoperative and postoperative radiographic analysis, physiotherapy data, patient-based outcomes s...

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“…However, functional outcome in youth and adulthood as well as a personal satisfactory cosmetic outcome in youth and adulthood are the major important determinants. In the scarce literature on long-term outcomes of patients with significant limb deformities that were lengthened with reconstruction and those patients that had a primary amputation, there was no significant difference in outcome in both performance as well as quality of life [8–12]. Limitations of these studies are heterogeneity of the groups.…”

Section: The Dilemmas In Reconstruction Versus Amputationmentioning

confidence: 99%

Amputation and rotationplasty in children with limb deficiencies: Current concepts

Sakkers

Wijk

2016

Journal of Children's Orthopaedics

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PurposeAmputations and fitting surgery have a long history in children with limb deficiencies. With the current developments in limb reconstruction and new techniques in prosthetics, the indications for amputation and fitting surgery might have shifted, but still have a very important role in creating high functional performance, optimal participation and quality of life. The purpose of this current concepts article is to give an overview of the indications, dilemmas and technical considerations in the decision-making for amputation and fitting surgery. A special part of this overview is dedicated to the indications, variations and outcomes in rotationplasties.MethodsThe article is based on the experience of a multidisciplinary reconstruction team for children with complex limb deficiencies, as well as research of the literature on the various aspects that cover this multidisciplinary topic.ResultsFor those children with a more severe limb deficiency, reconstruction is not always feasible for every patient. In those cases, amputation with prosthetic fitting can lead to a good result. Outcomes in quality of life and function do not significantly differ from the children that had reconstruction. For children with a postaxial deficiency with a femur that is too short for lengthening, and with a stable ankle and foot with good function, rotationplasty offers the best functional outcome. However, the decision-making between the different options will depend on different individual factors.ConclusionsAmputations and rotationplasties combined with optimal prosthesis fitting in children with more severe limb deficiencies may lead to excellent short- and long-term results. An experienced multidisciplinary team for children with complex limb deficiencies should guide the patient and parents in the decision-making between the different options without or with prosthesis.

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Long-term follow-up of Van Nes rotationplasty in patients with congenital proximal focal femoral deficiency

Cited by 47 publications

References 29 publications

Common Patterns of Congenital Lower Extremity Shortening: Diagnosis, Classification, and Follow-up

Common Patterns of Congenital Lower Extremity Shortening: Diagnosis, Classification, and Follow-up

Lengthening With External Fixation Is Effective in Congenital Femoral Deficiency

Amputation and rotationplasty in children with limb deficiencies: Current concepts

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