Rotationplasty: A Ray of Hope For Kids With Lower Limb Bone Cancers

At a young age of 5 or 7, when most kids are busy playing kickball or building blanket forts, Atharv Tiwari and Mohammad Irfan were dealing with the most challenging times of their lives. At that age, when they might not possibly be aware of what cancer is, they were victims to one of the rarest types of cancer, known as osteosarcoma. For the same, they were introduced to an entirely different technique of limb salvaging called Rotationplasty, something that the parents had never heard of. They were brought to Max Super Speciality Hospital, Saket. Although it is a well-described surgery, rotationplasty performed very rarely, because of a lack of awareness of the benefits of this surgery and the lack of surgical expertise required for this complex surgery.

Rotationplasty - Case History

Atharv had the sarcoma at the upper femur, near the hip joint measuring 9X3 cm, while Md Irfan had a 10 cm tumour, near the knee. After understanding the condition of their children from the doctors and available treatment options, both the families could only rely on Rotationplasty to save their children and retain their limb functionality as they grew up. Irfan who had undergone chemotherapy at his hometown in Bihar before coming to Max Healthcare, Saket, was seven years three months old when he underwent surgery. As Atharv was just five and arrived with more significant complexity due to the location of his sarcoma (near the hip joint), challenges with his function were much higher as compared to rotationplasty around the knee. At such a young age theses children underwent a rare and complicated rotationplasty surgery.

Dr Akshay Tiwari, Associate Director & Head, Musculoskeletal Oncology, Max Super Speciality Hospital, Saket/ Shalimar Bagh explains, “Rotationplasty is a surgery in which cancer-bearing segment of a limb (mostly leg) is removed entirely, leaving the upper and lower parts of the limb connected only with the nerves and vessels. The lower segment of the limb is rotated 180 degrees and is fixed to the upper segment. The foot of the patient now faces backwards so that the ankle acts as a new knee joint. Once the bones unite, the child has an excellent functioning after putting on a below-knee prosthetics. Unlike amputation and limb, salvage rotationplasty is a durable one-time solution, affordable, will lead to equal limb lengths at the end of growth, and with an excellent function of the limb."

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The Plus Effects of Rotationplasty

Dr Tiwari adds, “One of the key advantage of rotationplasty compared to other surgical options is that it allows the child to have an active lifestyle. With full amputation, the child wouldn’t have been able to do high impact sports or jumping. These kids Atharv and Irfan, who have their entire life yet to begin rotationplasty saves them from physical as well as mental trauma that other processes like amputation can bring along. With rotationplasty, they will be able to participate in sports, which may include running, baseball and cricket.”

Bone Cancer In Kids

Bone cancer is the rarest form of cancer globally (all age groups combined), but in kids, the occurrence is higher as compared to adults. Symptoms of the disease include swelling and pain around the joint, most commonly near the knee. Almost 2% of all cancer cases to be of bone cancer. Dr Tiwari adds there can be two types of bone cancer depending on the extent of spreading.

• Localised – when the cancer is restricted to where it started
• Metastatic – cancer cell spread to distal organs commonly lungs through the blood.

Dr Ramandeep Singh Arora, Principal Consultant, Pediatric Oncology, Max Super Speciality Hospital, Saket, shared his insights on children’s cancer cases in India. He said “If picked up early, these cancers are curable. Though the incidence rate of cancer in India among children is approximately 3%, yet appropriate medical facilities are not available everywhere. Rotationplasty is one such surgical method that is selectively done at few centres, is a beneficial procedure that gives a long-lasting, good functional limb to these children. These children here can lead a life at par with any normal individual, without hindering their growth or mobility in the long term.”

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Bone Cancer Diagnosis

Usually subjected to local imaging of the affected part in the form of X-ray and MRI. The child will undergo CT scan of lungs and whole-body bone scan to rule out the chances of metastatic diseases. Finally, the diagnosis is established by performing a biopsy.

Care After Rotationplasty

A child who has undergone rotationplasty can walk with support after a month and prosthetics. Free walking, without assistance, is dependent on healing. Ideally, it takes 3-6 months for a patient to walk without support. With physiotherapy and rehabilitation, before they can start using their ankle as the new knee joint and walk with below the knee prosthetics. Most children adapt very well to the changes in body form and start running and playing in due course.

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