This reconstructive procedure is used in a skeletally immature patient after en bloc extra-articular resection of osteosarcoma about the knee (see Plate 6-33). The technique was devised by Van Nes in 1950 for the reconstruction of severe congenital defects of the femur and has been widely used in Europe to treat sarcoma in young children. After resection of the diseased bone, the remaining tibia is rotated 180 degrees to the proximal femur and fixed to it with plates. The redundant vessels are carefully looped in the soft tissues. The length of the newly created limb is adjusted so that the ankle is positioned at the level that will match the level of the contralateral knee at completion of growth. The rotated ankle functions as a knee joint, and the foot serves as the stump of a below-knee amputation. Rotationplasty provides a better functional result than above-knee amputation, but the patient must be willing to accept the unusual cosmetic appearance. However, this procedure is being used less frequently because there are now prostheses that can be lengthened.
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