Rehabilitation Treatment after Knee Rotationplasty in a Convalescent Rehabilitation Ward：A Case Report / The Japanese Journal of Rehabilitation Medicine

Knee rotationplasty is a surgery wherein the rotated ankle serves as the new knee joint after resecting the original knee joint and lesion. However, details of postoperative rehabilitation treatment in a convalescent rehabilitation ward are not well-known. Therefore, we reported the rehabilitation progress of a 36-year-old man who underwent knee rotationplasty in the convalescent rehabilitation ward. In the early postoperative period, the surgery required no weight bearing on the operated lower limb until bone healing. Even during this period, we conducted physical therapies such as joint range of motion training and muscle strength training as outpatient rehabilitation therapy. After being admitted to the convalescent rehabilitation ward, physical therapy was intensified and the patient's rotationplasty prosthesis was then fabricated and fitted by a prosthetist and orthotist. The patient was discharged 80 days after his hospitalization and could eventually walk stably with his prosthesis and returned to work. In Japan, the length of stay in a convalescent rehabilitation ward is limited. If patients are provided with enough physical therapy during the postoperative course and rotationplasty prosthesis by a skilled prosthetist and orthotist, rehabilitation treatment after knee rotationplasty can achieve good results in a convalescent rehabilitation ward.

Five Osteosarcoma of the lower extremity treated by Rotationplasty: University of the Philippines - Philippine General Hospital Experience

@#Functional and oncologic results of the initial series of children with osteosarcoma treated with rotationplasty at the University of the Philippines - Philippine General Hospital from 2014 to 2015 are reported. Five children (mean 13.2 years) with Enneking IIB osteosarcoma of the lower extremity underwent neoadjuvant chemotherapy, tumor resection with wide margins, and rotationplasty – four Winkelmann Type AI and one Type AII. The four Type-A cases were fixed using an intramedullary nail and the Type A2 case with a plate. Two cases had >90% tumor necrosis. Adjuvant chemotherapy was started 10 to 21 days following surgery. Functional results for the AI rotationplasty showed a good range of motion of the ankle (neo-knee) with preserved muscle strength. The patient with AII rotationplasty had a fair range of motion of the ankle with some muscle weakness. All had radiographic evidence of healing at an average of 12 weeks. The oncologic outcome showed two with local recurrences at five months from surgery; three died of disease at 7, 20, and 38 months; while two are alive without evidence of disease at 72 and 84 months. Three patients were able to fit with a prosthesis with good utility, ambulation status, and satisfaction.

Using Video Recording in Evaluating Skills of Medical Students in the Performance of the Orthopedic Examination

@#OBJECTIVE: The study aims to assess the similarity between the results of the evaluation of students during an Objective Structured Clinical Examination (OSCE) and a video recording of the same OSCE (VOSCE). METHODS: All Orthopedic surgeon preceptors in the actual OSCE were recruited to the study. Video recordings of the students taking the OSCE were collected and later reviewed and re-evaluated by the same preceptor after at least four weeks. The grades of actual OSCE and VOSCE were collected and analyzed using Cohen’s kappa coefficient. RESULTS: High variability of intra-rater reliability was observed in different preceptors and station (slight agreement to perfect agreement). Overall intra-rater reliability between actual and video OSCE showed moderate agreement with Cohen’s kappa coefficient equal to 0.43 (n-219). CONCLUSION: Video OSCE is a reliable tool in assessing student clinical skills and knowledge in the musculoskeletal examination. Some factors have been suggested to further improve reliability.

Application of rotationplasty in treatment of osteosarcoma of distal femur in children / 中国修复重建外科杂志

Objective: To investigate the effectiveness of rotationplasty in treating osteosarcoma of distal femur in children. Methods: A clinical data of 10 children with osteosarcoma of distal femur treated with rotationplasty between March 2014 and June 2016 was retrospectively analyzed. There were 7 boys and 3 girls with an average age of 6.7 years (range, 4-10 years). There were 4 cases of osteoblastic osteosarcoma, 4 cases of mixed osteosarcoma, and 2 cases of chondroblastic osteosarcoma. All children were staged as Enneking stage ⅡB. The disease duration ranged from 3.5 to 6.0 months (mean, 4.6 months). The lower limb functional scoring system of 1993 Musculoskeletal Tumor Society (MSTS93), Toronto Extremity Salvage Score (TESS), and knee mobility were used to evaluate postoperative function. Tumor recurrence and metastases were monitored by radiograph. Results: Poor superficial incision healing occurred in 1 patient, and healed after dressing change. The other incisions healed by first intention. All children were followed up 24-72 months (mean, 52.6 months). No local recurrence was observed during follow-up. Three of the ten patients suffered from metastases including 1 dying of multiple organ dysfunction syndrome, 1 alive with tumor, and 1 tumor free survival. Painful callosities and ulcers which related to prosthetic wear occurred in 2 patients and turned up after optimizing prosthetic fit and physiotherapy. The fracture healing time was 2.5-5.0 months (mean, 3.5 months). All children could walk independently at 4 months postoperatively. At last follow-up, the MSTS93 score was 19-25 (mean, 22) and the TESS score was 87-93 (mean, 90). The extension of knee joint mobility with artificial limbs was 0°-10° (mean, 5°), and the flexion of knee joint mobility with artificial limbs was 85°-95° (mean, 90.5°). Conclusion: Rotationplasty in treating osteosarcoma of distal femur in children with limb salvage difficulties can effectively preserve the limb function and improve the quality of life, and it can be used as an alternative to amputation.

Surgical Treatment of Malignant and Aggressive Bone Tumors Around the Knee by Segmental Resection and Rotationplasty

In patients having malignant or aggressive bone tumors around the knee joint and requiring amputation, segmental resection and rotationplasty was performed and the clinical results were analyzed. Twenty-six patients underwent segmental resection and rotationplasty between February 1988 and June 1994. The mean follow-up period was 57 (6 - 120) months and the average age of patients was 21.4 (5 - 37) years. Out of 26 patients, there were 18 osteosarcomas (> or = stage IIB), 2 synovial sarcomas, and 6 giant cell tumors. Clinical results were evaluated by the Shriner's rating system. Four patients were excluded due to death or amputation and the remaining twenty-two patients were included for assessment. Eighteen patients had excellent results, 3 good, and 1 fair. Range of motion of the ankle joint was -11 (dorsiflexion) - 80 (plantarflexion) degrees and daily walking activity was possible. Local recurrence developed in 2 patients and distant metastasis in 10. Early complications include 3 thromboses and 1 sepsis, and late complications were 6 nonunion, 2 malrotation and 1 stiffness of the ankle joint. Rotationplasty, which is functionally excellent, may serve as an effective partial limb salvage procedure, especially in patients younger than 10 years old who are expected to have leg length discrepancy or loosening of the tumor prosthesis due to the growth of the medullary cavity or when amputation is inevitable for a wide resection margin.

Segmental Resection and Rotationplaty for Malignant and Aggresive Benign Bone Tumors about the Knee / 대한정형외과학회잡지

A segmental resection and rotationplasty was performed in 23 patients with malignant and aggressive benign tumor of the distal femur or proximal tibia between February 1988 and September 1992 at the Severance Hospital. There were 13 male and 10 female patients. The yongest was 5 years old and the oldest was 37 years old. Mean age at operation was 26.2 years. Of the 23 cases, 14 were osteosarcoma, 7 were giant cell tumor and 2 were synovial sarcoma. After an average observation period of 32.5 months, there was no evidence of local recurrence but 6 distant metastases were developed. According to Shriner's rating scale, the functional result were excellent or good in all cases. All patient were convinced that they had chosen the appropriate operative procedure and the ability to achieve high level of activity was considered as the main benefit.

A Rotation / 대한정형외과학회잡지

Rotation-plasty provides useful knee function and permits use of what is essentially an end-weight-bearing below-the knee prosthesis. This principle of rotating the foot was first used by Borggreve in 1930(3), in a patient with a short femur secondary to infection. Since then, this procedure has been used in congenital short femurs(4,6,7,), malignant bone tumors of the distal femur(1,5)and compound fracture with wide bone defect around the knee(2) We have performed this procedure in a case of focal femoral deficiency with 14cm shorter than the opposite femur due to long standing persistant chronic osteomyelitis in the mid-shaft femur of a nine-year old Korean boy and gave the good result with a conventional but slightly modified below- the-knee brace. The inverted foot was good to control the brace as a below-knee stump and heel functioned as a patella to support the body weight.

Rotation / 대한정형외과학회잡지

Rotation-plasty procedure was first done by Borggreve, in 1930 for the congenital short femur. Recently this procedure was used for the malignant bone tumor at the distal femur by Kotz and Salzer in 1982. In spite of its cosmetic problem of the distal stump, this procedure has great functional advantage of converting the above-knee amputation to the below-knee amputation. The authors applied this procedure in case of severe soft tissue crushing and large bone defect from the distal femur to the proximal tibia by the rail-road accident. Conventional below-knee prosthesis with thigh corset gave him normal ambulation. The inverted foot was good to control the prosthesis as a below-knee stump and heel functioned as a patella to support the body weight.