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Dear All

Yesterday on tv there was a news item about a male model who had cancer in the left femur. The leg required amputation. The surgeons removed the knee and 3/4 of the femur leaving the neck and GT and relaced it with the shank and foot of the same leg. The ingeneous thing was that they fitted the shank back to front. In this way a new prosthetic lower limb could be fitted to the foot and ankle, which now acts as a knee.
The patient returned to his modeling career and is a very keen football player.

Now how great is that! Has anyone come across this technique before?

Chers Dave Smith

Before I would say "how great is that", I would first want to see how the patient functioned and how he was satisfied with this experimental surgery. Sometimes surgeons, in their zeal to be the first to do a procedure and therefore possibly have their name pinned to it, use a technique that is an absolute failure and even harmful to the patient, whereas if they were just to do the procedure in the time-tested manner, things would have worked out better for the patient. However, innovation in any medical specialty sometimes requires the physician to do something no one has done before that may lead to either success or failure. Time is always the best judge of success in these cases.

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Sincerely,

Kevin

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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
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I have seen pictures of it in several prosthetic textbooks. The foot/ankle complex is attached to femur backwards to allow better functioning of the prosthesis.

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Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
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God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Craig,

This proceedure has been done for many years as you state. The resulting prosthesis relies on ankle range of motion and power to create a "pseudo" knee. I have seen a few cases, none had normal knee function as the transer and rotation significantly reduces muscle power and often requires external bracing to stabilise the joint.

There are quite a few people now using endo prosthesis to replace the amputatated femur/knee and tibia with implanted titanium components. The soft tisuues are then reattatched. This requires loads of rehab but function 12 months post op is excellent.

The question has to be asked whether the patient described in this post would function better with a transfemoral amputation and and good prosthesis. Rehab time would certainly be much shorter?

Sometimes it appears that these types of proceedures try to perform some kind of salvage for the limb to benefit the patient. Is this a surgeons view or a functional view? The same can be said for certain diabetic related partial foot amputations.....

What do u think?

Hi Dave,

The procedure's called a Van Ness Tibial Rotation (sometimes rotationplasty). They use it quite commonly at the Royal Childrens' Hospital here in Melbourne for kids with femoral osteosarcomas and it's been around for quite some time as someone else said.

From memory, they also do a triple arthrodesis so that the ankle behaves like a knee. Its main advantage is that the prosthesis is a lot easier to use and more stable during gait than a transfemoral one (there's one less joint to learn to use). It does get a little surreal seeing one of the stumps for the first time though.. a bit like prosthetics by Gary Larson.

cheers,

Rich

Kevin

Yes I can see what your saying and agree but the guy seemed as Happy as Larry with the "New leg" but as you say time will tell. Interesting that Richard says it's quite common in Australia. What sort of long term complications are there? Not being a doctor or surgeon this may sound naive but if the Van Ness Tibial Rotation procedure fails is it not possible to revert to a conventional prosthesis? If so there's nothing lost by trying this first. is there?

I'm thinking there may even be advantages in the fact that if the ankle fails you still have a long stump to connect a prosthesis to.

Cheers Dave Smith

Dave:

I just talked to the orthopedic surgeon I work with and he said this procedure is fairly old, probably started in the 1930's-1940's. He also said it works well but is somewhat "grotesque" when the prosthesis is off the limb. He doesn't know of any orthopedic surgeons who still do the procedure in the US and hasn't ever seen one performed in his 25 years of practice. So, I was wrong. It is not a new procedure, it does seem to work well functionally, but seems cosmetically to be a problem for some patients. I don't know if I would want a foot attached backwards to my knee and hope I never need to make that decision in my lifetime.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Netizens

More details can be found at :
http://www.amputee-coalition.org/inm...ionplasty.html

Cameron

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Cameron Kippen, Podologist and Shoe Historian




Cameron Kippen