A five-year-old bone cancer patient has been given a second lease on life after undergoing the country’s first rotationplasty procedure in Cape Town, a complicated operation to treat bone cancer of the lower limb where standard limb-saving reconstructions are impossible.
The child, diagnosed with osteosarcoma in her right femur, underwent the Van Ness rotationplasty procedure at the Life Vincent Pallotti Hospital at the hands of a specialised Life Orthopaedic Hospital team.
The procedure consists of shortening of the leg with a rotation of 180 degrees of the lower leg, which is adapted to the remaining upper leg bone (femur), changing the ankle function into a new knee joint.
Orthopaedic oncology and joint replacement surgeon Dr Thomas Hilton said: “The procedure provides patients with more function than a traditional amputation would, as the patient’s ankle acts as a substitute for the knee joint. It allows a prosthesis to fit more comfortably, providing better leg mobility and stability than patients who undergo a full high above knee amputation.”
Hilton met the five-year-old patient, who had bone cancer in the lower part of the thigh bone (femur), when he travelled to Namibia for an orthopaedic oncology outreach programme in the Windhoek Central State Hospital, reports the Cape Times.
“Standard limb salvage procedures were not possible for the child due to the extent of the tumour and a Van Ness rotationplasty was deemed to be the best surgery for her,” he said.
He led the unique six-hour pro bono procedure at Life Orthopeadic Hospital with support from Life Vincent Pallotti Hospital specialists and Dr Alma De Waal, an anaesthetist from Groote Schuur Hospital.
“This is a great example of how public-private partnership can help patients,” he said.
Hilton explained that standard methods used mega-prosthetics or healthy bone tissue transfers with titanium plating systems. In a Van Ness rotationplasty, the middle and lower section of the femur, including the knee, is removed, along with the cancer, and the lower shin (tibia), ankle and foot are then rotated 180 degrees and reattached to the remaining thigh or femur bone.
He said a rotationplasty was more common in young children because they had so much growth remaining in their skeleton that standard prosthetics would leave them with a limb that would be too short to be useful.
“Most children recover well and are likelier to adapt to the prosthesis because they are young and learn much faster than adults. They can usually resume activities such as running, ballet, climbing trees or playing soccer.”
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