Rotationplasty is one treatment option for femoral bone sarcomas in skeletally immature patients. This procedure enables patients
to avoid phantom pain, limb length discrepancy, or loosening of an endoprosthesis, and good functional outcome has been reported.
However, rotationplasty is only rarely indicated and the surgical complications or risk factors for failure of the procedure
that might influence choices of treatment or patient counseling have not been well described. We reviewed 25 patients who
underwent rotationplasty focusing on risk factors for failure and postoperative complications. Three of 25 patients had vascular
compromise resulting in amputation. All three had vascular anastomosis and were resistant to chemotherapy with less than 95%
of tumor necrosis. Two of the three patients who underwent amputation had a pathologic fracture before surgery. Late complications
included one patient with a tibial fracture, two with wound complications treated with skin grafts, one with nonunion, and
one with subsequent slipped capital femoral epiphysis. Rotationplasty was successfully accomplished in 22 of the 25 patients.
Patients with large tumors unresponsive to chemotherapy or preoperative pathologic fracture appear at higher risk for failure
of rotationplasty presumably as a result of compromise of venous drainage of the leg.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has 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.