Prosthetic management 56 years after rotationplasty due to proximal femoral focal deficiency (PFFD)

Abstract

Proximal femoral focal deficiency (PFFD) is a rare congenital anomaly of the femur. Rotationplasty has been described as a reconstructive procedure in the management of PFFD. A 68-year-old woman with PFFD of the right leg and rotationplasty at the age of 12 years had prosthetic fitting problems after a fall. The authors describe the analysis of the prosthetic fitting problems and the considerations made in prosthetic management. Following a fall, 56 years after rotationplasty, this woman has a good prosthetic fitting and a satisfying level of functioning.

Rotationplasty as a salvage of failed primary limb reconstruction

“…Absence of pain, together with the preservation of articular and cutaneous proprioception, is an important advantage in improving the application of prosthesis and the function of the amputated limb [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][20][21][22][23][24]26,27].…”

“…Rotationplasty can provide good functional results but requires cooperation of the patient and the family [6][7][8][9][10][11][12][13][14][15][20][21][22][23][24]. The procedure has several advantages such as sensible distal stump allowing good distal support, absence of painful neuroma after amputation, no occurrence of phantom limb phenomenon, no bony overgrowth at the distal end of the residual limb, conservation of ongoing skeletal growth, and conservation of active mobility of flexion-extension of the reconstructed knee joint.…”

“…The procedure has several advantages such as sensible distal stump allowing good distal support, absence of painful neuroma after amputation, no occurrence of phantom limb phenomenon, no bony overgrowth at the distal end of the residual limb, conservation of ongoing skeletal growth, and conservation of active mobility of flexion-extension of the reconstructed knee joint. Moreover, it is a better treatment option than a classical trans femoral amputation, as reported by several studies [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Moreover, it is a better treatment option than a classical trans femoral amputation, as reported by several studies [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”

“…Cleft palate, longitudinal fibular deficiency, clubfoot, congenital heart defects and spinal defects can be associated with PFFD in up to 70% of cases [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. It is characterized by failure of normal development of the proximal femur and hip joint, resulting in limb shortening and pelvic abnormalities.…”

Amputation and rotationplasty in children with limb deficiencies: Current concepts

“…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][9][10][11][12]. Limitations of these studies are heterogeneity of the groups.…”