Long-term functional outcome and quality of life following rotationplasty for treatment of malignant tumors

Abstract

BackgroundMalignant bone tumors of the lower extremity are more frequently found in children and adolescents than in adults. Modern treatment regimens led to high limb salvage rates and offer the choice between endoprosthetic replacement and rotationplasty in many cases. Rotationplasty has proven to be an effective, highly functional option in short- and mid-term studies. Aim of this study was to assess long-term results regarding quality of life and functionality after rotationplasty and to compare the obtained results to a representative healthy German sample cohort.MethodsIn total 12 patients who underwent rotationplasty between 1991 and 2001 were enrolled in this study. After physical examination, they were evaluated regarding health related quality of life, functional outcome and psychosocial status. While quality of life was mainly assessed using the SF-36 (The Short Form (36) Health Survey v2), functional outcome was measured using the musculoskeletal tumor society score (MSTS) as well as the Tegner activity level scale.ResultsAverage age at the time of surgery was 19 ± 10 year. and 32 ± 11 year. at the time of follow up. Mean follow-up was 14 ± 9 years. The SF-36 scores accounted for 80.4 ± 15.7 regarding physical functioning, for 78.1 ± 24.1 regarding the physical role functioning, for 74.1 ± 17.6 regarding bodily pain and for 71.8 ± 26.1 regarding general health. SF-36 score for vitality was 75.0 ± 12.8, for social functioning 98.9 ± 3.6, 88.2 ± 23.9 for emotional role functioning and 89.6 ± 10.1 for the mental health. Comparison to a representative German sample cohort revealed significantly higher patient’s scores for vitality, social functioning and mental health (p < 0.05). The overall MSTS resulted in an average of 64 ± 12 % and the Tegner activity level scale accounted for 4.1 ± 0.6 pts.ConclusionsThe presented long-term results indicate that rotationplasty provides a high quality of life. Patients are satisfied with a good functional outcome regarding activities of daily life and even sports.

Pediatric Malignant Bone Tumors: A Review and Update on Current Challenges, and Emerging Drug Targets

“…In conjunction with intensive physical therapy, rotationplasty has been associated with excellent functional outcome and a high likelihood of the patient being able to participate in sports. 39,40 The most common long-term effects associated with rotationplasty include local skin and soft tissue changes located in and around the main loading areas of the rotated foot. Asymptomatic adaptive radiographic osseous changes were observed in 25% of patients, but no pathological degenerative Today, amputation is used only in a select number of cases, as the vast majority of malignant tumors of the long bones are treated with limb-sparing procedures.…”

Review of Osteosarcoma and Current Management

“…Most expandable prostheses will eventually have to undergo revision, given the age and activity level of their patients. Rotationplasty remains a useful and lasting option in patients with distal femur OS, especially for patients who desire high-demand activity, but few patients and their parents are comfortable with this type of amputation [111].

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Free microvascular rotationplasty with nerve repair for rhabdomyosarcoma in a 18‐month‐old patient

“…Rotationplasty permits wide resection, offering oncologic outcomes comparable to amputation but preserving a useful limb. Despite possible disadvantages as the cosmetic appearance of the rotated limb, difficulties in mental acceptance and possible need of subsequent bone lengthening and rotational osteotomies (as the limb might alter its rotatory alignment during growth), patients have high satisfaction rates, function, and quality of life (Gradl et al, ; Gupta et al, ). Because of active control of the neo knee joint, the walking speed, gait, oxygen consumption, and general functional scores are significantly better in rotationplasty patients compared with above‐knee amputees.…”

“…Because of active control of the neo knee joint, the walking speed, gait, oxygen consumption, and general functional scores are significantly better in rotationplasty patients compared with above‐knee amputees. In pediatric patients this procedure is associated with better outcomes compared with endoprosthesic replacement (Badhwar & Agarwal, ; Gradl et al, ; Gupta et al, ; Hillmann, Hoffmann, Gosheger, Krakau, & Winkelmann, ).…”

“…In malignancies of either the distal femur or the proximal tibia, after intercalary resection of the knee, the distal limb is rotated 180º in the longitudinal axis, and repositioned to allow ankle to function as a knee, which can be fitted with a custom‐made below‐knee prosthesis (Borggreve, ; Gupta, Alassaf, Harrop, & Kiefer, ; Van Nes, ). Good oncological, functional, and psychosocial outcomes have been documented with this procedure (Gradl et al, ; Steenhoff, Daanen, & Taminiau, ).…”