title: Indications for and surgical complications of rotationplasty.
abstract: BACKGROUND
  Rotationplasty is one treatment option for femoral bone sarcomas in skeletally immature patients. This procedure can also be used to save failed limb salvage procedures such as infected prostheses and failed bone grafts in adults. Rotationplasty is only rarely indicated, and the surgical complications and risk factors for failure of the procedure that might influence the treatment or patient choices have not been well described.
  
  
  METHODS
  We retrospectively reviewed 19 patients who underwent rotationplasty focusing on surgical indications, surgical procedures such as the type of rotationplasty, and whether vessels were sacrificed and reconstructed with vascular anastomosis or preserved. Risk factors for failure of rotationplasty were categorized into either early or late postoperative complications.
  
  
  RESULTS
  Thirteen of 19 rotationplasties were done for patients diagnosed with primary sarcoma, 3 patients for unplanned excisions of sarcomas, and 3 patients for infection. Two of 19 patients did not have sufficient circulation resulting in amputation. Six of 19 patients underwent vascular anastomoses, and all of these anastomoses were successful. Three patients had multiple operations for infection before rotationplasty, and one patient's treatment failed so an amputation was required. As late complications, one patient had delayed bone union and one had postoperative infection that healed after removal of plate fixation. Two patients had malrotation of the tibia that resolved with revision surgery. One patient had a skin ulcer that healed with conservative treatment. One patient who had an unplanned excision had a hemipelvectomy for non-union 11 months after rotationplasty.
  
  
  CONCLUSIONS
  Rotationplasty was successfully accomplished in 16 of the 19 patients (84 %) with sarcomas, unplanned excision of sarcomas or infection. Vascular anastomosis did not increase the risk of rotationplasty failure in our series. Patients appeared to have a higher risk of failure of rotationplasty after multiple operations, possibly because of inflammation around the vessels. The surgeon should be aware of the higher potential risk and consider vascular anastomosis for these patients.
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan. sawaorth@tmd.ac.jp
authors.forename: Chigusa
authors.initials: C
authors.lastname: Sawamura
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimoji
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ae
authors.forename: Taisuke
authors.initials: T
authors.lastname: Tanizawa
authors.forename: Tabu
authors.initials: T
authors.lastname: Gokita
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Koyanagi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Okawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical; D001850:Bone Diseases, Infectious / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D005266:Femoral Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult