Also known as limb-saving or limb-salvage techniques, are performed in order to give patients an alternative to amputation.
There are many different types of limb-sparing techniques including:
- Arthrodesis
- Arthroplasty
- Alloprosthetic composite
- Endoprosthetic reconstruction
- Prosthetic implants
- Rotationplasty
Arthrodesis is defined as, "the surgical immobilization of a joint so that the bones grow solidly together." Arthrodesis can relieve pain from arthritis and fractures. This is accomplished through the use of Allografts and Autografts. Allografts are done by creating bone grafts from a donor bone bank, while autografts are bone grafts from other bones in a patient's body. Synthetic bones and metal plates can also be inserted to abate the pain.
Arthroplasty is a lot similar to arthrodesis. It literally means "surgical repair of joint.' In the past, arthroplasty used tissue and removal of bone to relieve pain. Currently, joints are removed and replaced with prosthetic limbs. This alleviates pain, allows a greater range of motion, and improves walking ability, all of which strengthen muscles. Arthroplasty of the shoulder is one of the most common of these procedures, though it has only been widely used since 1955.
Alloprosthetic composites are a combination of multiple limb-sparing techniques. Allografts are used to replace the bone that has been "resected" using arthroplasty techniques. Prosthesis is then used to support and strengthen the allografts. Alloprosthetic composites are felxible in that surgeons can adapt the implants for any situation.
Prosthetic implants are used when sections of bone must be replaced, but only no further growth is expected. Implants are mostly made from metals but the possibility of using ceramic material has been discussed among surgeons. Prosthetics can be temporary or permanent. Temporary implants remain in place until the bone has healed and is then removed. The temporary implants take most of the burden off of the fracture, causing the bone to become less dense. This can lead to the re-fracturing of the bone after the implant is removed. The implants can also cause stress concentrations, as a result of the material difference between the bone and the plate. With the permanent prostheses, a putty like substance is injected into the implant site to keep the body, mainly the immune system, from fighting off the implant. This substance can deteriorate bony tissue and cause serious bone problems for the patient. Prosthetic limbs have been used for many years.
Rotationplasty, more commonly known as Van-Nes or Borggreve Rotation, is a limb-sparing medical procedure performed when a patient's leg is amputated at the knee. The ankle joint is then rotated 180 degrees and is attached to the former knee joint, becoming a new knee joint. This allows patients to have two fully functional feet, as opposed to losing one leg completely to amputation.
Reasons for Rotationplasty
Originally, rotationplasty was performed to treat infections and tumors around the knee. It was also a common treatment for osteosarcoma. While it is still being used to treat their complications, rotationplasty is also used to treat growing children who have been diagnosed with tumors around the knee. Rotationplasty is also performed on children with congenital femoral deficiencies. Those deficiencies cause "unstable hip joint[s] and a femur that is 50% shorter than the contralateral, normal femur." This procedure gives rotationplasty patients the ability to have the use of both feet and allows them to continue living an active lifestyle.
Rotationplasty Procedure
In the actual procedure, the bone affected by the tumor, as well as a small part of the healthy femoral and occasionally tibia bone, is removed. A portion of the leg removed, the ankle joint, is then turned 180 degrees and is reattached to the thigh. They are held together by plates and screws until they have healed naturally. The surgery can take anywhere from 6 to 10 hours, with a day or two in intensive care. The leg is kept in a cast for 6 to 12 weeks. After the leg has sufficiently healed, the leg can be fitted for a prosthetic.
Advantages and Disadvantages of Rotationplasty
In the same scenario, amputation would not leave a knee joint. Rotationplasty allows the use of a knee joint. Furthermore, it provides a better position for a prosthetic limb. As a result, children who have had rotationplasty can play sports, run, climb, etc. Rotationplasty is also durable. Patients do not typically have to undergo additional surgeries throughout their lives. Unfortunately, not every case turns out favorably. Rotationplasty can result in problems with blood supply to the leg, infection, nerve injuries, problems with bone healing, and fracture of the leg. Also, the appearance of the leg after rotationplasty is unusual to most people.
