MY ANKLE IS MY KNEE: DEFEATING BONE CANCER
Team Lumina
04/08/2018
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Medical science has done wonders for human life throughout its history, and even today, it continues to tackle sicknesses of all sorts, the latest of which is bone and joint cancer. With 0.4 deaths per 100,000 people between 2011 from 2015, this particular type of cancer has emerged as a looming peril. However, humankind has not succumbed to this source of despair. Thanks to Dutch Orthopedist Cornelis Peiter Van Nes, Rotationplasty has had patients spring back from utter despondency to once again appreciating the colors of life.
Malignant bone tumors (such as those in the distal femur), osteosarcoma, Ewing’s sarcoma, congenital limb deformities and infected prosthetic implants often end with patients being left with no option, but to have a limb-salvage surgery (which leaves the limb much weaker after the surgery, limiting usage of the related joint) or, in the worst-case scenarios, amputations. These severe measures, though necessary, leave the patients psychologically damaged where their life perspective dulls, making recovery even more difficult. The maximum these patients can potentially do often remains unexploited. Rotationplasty is something that has been shown to break these trends.
“Now Gabi, from Missouri, America, can bend and flex her prosthesis by moving her foot and is now encouraging others to 'live their dreams' and 'never give up'.”
Rotationplasty is a very old concept that was originally performed by Peiter Van Nes. Later modified by Brown in 1996 and Paley in 1997, rotationplasty has proved to be an excellent alternative for many of the most severely deficient cases. The original operation comprised of the patient’s knee acting as the new hip and the ankle serving as a knee. However, adapting to recent trends, where the knee joint is often affected by cancer or some other serious infection or injury, the knee joint is cut out and the lower leg is attached to the thighbone, with the ankle serving as the knee.
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First, the bottom of the femur, the knee, and the upper tibia are surgically removed while the nerve endings, arteries and veins of the lower leg and the thighbone are preserved. The lower leg is rotated hundred and eighty degrees (hence, the name ‘Rotationplasty’) and then attached to the thighbone. The foot is now at the end of the thighbone and since it is backwards, it can act like a knee. Children between the age of five to twelve years often receive this operation as they have the capacity to learn the use of their ankle as a knee. Through physical therapy instruction, most patients are able to gain command of their new joint’s use. With the use of a prosthetic leg, patients have much more mobility than they would with a full knee amputation. Many patients hesitate initially as the appearance of the leg is quite unusual, but the use of a prosthetic counters that effectively.
The most suitable candidates for receiving Rotationplasty are often young children where the bone will grow with the child. Furthermore, researchers at MIT have developed prosthetics that also grow with the patients, which are not only cost effective, but also easier for patients to adapt to. Young children are also better able to re-train their brain to learn to use their ankle as a knee. Rotationplasty also enables children to play high-impact sports and jumping. Since the nerves are not cut, there is no phantom pain either, allowing children a much more active lifestyle. Though it is not the best option in all cases, Rotationplasty has been shown to give patients a very optimistic outlook on life.