Amputation and Van Ness Rotationplasty
When a patient has cancer in a limb, he or she will usually undergo chemotherapy, radiation, and/or surgery first. The physician may recommend limb removal when it is no longer possible to save the limb or if the patient is skeletally immature. This can be done either through amputation or through Van Ness rotationplasty.
Amputation involves removing the limb with a wide resection margin starting above the tumor. This means that the tumor will be removed along with normal tissue. Usually this involves parts of either the arms or legs, but it can also include the hip or shoulder. Within one month after surgery, the patient will be fitted for a prosthesis.
Van Ness rotationplasty is the removal of the tumor plus the joint. This always involves the distal femur and proximal tibia, or the knee joint. After removing the bone tumor, the distal limb (the part of the limb farthest away from the body's center) is attached to the proximal limb (the part of the limb closest to the body's center) with the foot facing backward. The foot then acts like the knee joint and a prosthesis is attached to it. This allows the patient to control the movement of the prosthesis much better.
There are several limitations and complications with amputation and Van Ness rotationplasty. The prosthesis may be difficult to fit onto the foot or stump. The patient has a decreased range of motion, and in children there may be frequent prosthesis changes.
Fortunately, with the advances in chemotherapy and radiation, most tumors can be shrunk prior to surgery. This leads to a much less extensive operation and perhaps even makes limb salvage possible. It is important to remember that there are some cases that require amputation or Van Ness rotationplasty when the patient's survival is at risk. Although these procedures are rarely performed in the US, there are many places around the world that only treat bone cancer patients with amputation or Van Ness rotationplasty.