What is a rotationplasty?
Valerae O. Lewis, M.D.
The Orthopaedic Oncology department at MD Anderson offers treatment for adults and children with musculoskeletal tumors. We evaluate many different types of disorders, including benign and malignant bone and soft tissue tumors, as well as metastatic lesions. We also manage orthopaedic problems in oncologic patients, who require specialized, multidisciplinary care in a comprehensive cancer center. Such problems include fractures, arthritis, avascular necrosis and osteoporosis.
One of the main objectives of the Orthopaedic Oncology department is to provide state-of-the-art treatment for primary bone tumors. Osteosarcoma, Ewing's sarcoma, Giant Cell tumors, chondroblastoma, chondrosarcoma, chordoma, and soft tissue sarcomas are some of the diseases that we treat most often. Our goal is to maximize the function of each patient with advanced surgical and reconstructive techniques.
Internal hemipelvectomy is a technically demanding surgical procedure performed for the treatment of pelvic tumors. During the procedure, a portion of the pelvis is removed while preserving blood supply and nerve function to the limb. Various reconstructive options are available to the surgeon depending on the exact location of the tumor. In 2011, the Orthopaedic Oncology department established the multidisciplinary Pelvic Sarcoma Team. This encompasses over 14 physicians from different surgical subspecialties who are dedicated to the care of pelvic sarcoma patients.
Resection of a sarcoma involves removal of the tumor with a cuff of normal tissue - this ensures the entire removal of the tumor. This can require the removal of an entire muscle group, the lining of the bone and ligaments or tendons. Expertise in limb salvage facilitates the best functional outcomes for the patient. Resection should be performed in a manner to maximize both oncologic and functional outcome.
Removing bone tumors in children frequently requires removal of one of more of the bone's growth plates. This can result in significant shortening of the limb when compared to the unaffected limb that continues to grow normally. Expandable prostheses can be used to non-invasively lengthen the limb. This is done by lengthening the prosthesis in small increments over time. The lengthening process is performed during follow up clinic visits and is done without further surgery or anesthesia.
En bloc spinal resection is complex surgery designed to remove tumors within the bones of the spine. The goal of an en bloc resection is to achieve a complete resection of the tumor in one piece, decreasing the risk of tumor spread during removal. Multiple vertebrae may be removed. Once the tumor has been removed, spine reconstruction is performed to maintain spine stability and maximize function.
A rotationplasty involves removing the impacted portion of the bone together with the knee joint, then rotating the lower portion of the leg 180 degrees before reattaching it. Because of the rotation of the lower limb, the ankle is now on the same plane where the knee used to be, with the foot and toes pointing backward and the heel facing forward. The ankle now bends where the knee used to bend. In pre-operative planning, the physician will take into account the age of the child and their growth potential. Given the prediction of growth remaining, the surgeon will incorporate this into the surgical-resection plan. The knee centers of both the operative and non-operative side will be equal when the child stops growing.
Computer assisted navigation surgery is specialized surgery utilizing complex 3D imaging in real time to help the surgeon localize the tumor and the surrounding critical structures. This helps the surgeon navigate complex anatomy often distorted by the tumor. This surgery improves the accuracy, precision, and safety of the procedure and is commonly used in spine, sacral and pelvic tumor resections at MD Anderson Cancer Center.
Orthopaedic Oncology Videos
Musculoskeletal Oncology Fellowship
The Orthopaedic Oncology department offers a one- or two-year optional post-graduate fellowship in orthopaedic oncology. The fellowship is designed to provide specialized training in the multidisciplinary care of benign and malignant bone and soft tissue tumors. U.S. (United States) applicants must have completed an approved orthopaedic residency program by the starting date of the fellowship, and must be board eligible or board certified. Applicants from abroad must have a current ECFMG certificate and all three parts of the USMLE successfully completed. All candidates must demonstrate a strong commitment to academic medicine.
Learn more about the Musculoskeletal Oncology Fellowship.
Orthopaedic Oncology Observer Program
The Orthopaedic Oncology Observer Program offers orthopaedic oncologists the opportunity to visit MD Anderson Cancer Center's department to observe surgical procedures in the operating room. Participants are also able to attend multidisciplinary treatment planning conferences and weekly fellow didactic programs under the guidance of experts in the field. The volume of surgical procedures scheduled per week varies based on the activities of the faculty members.
Learn more about the Orthopaedic Oncology Observer Program.
Phone and fax
Academic Office: 713-745-4840
Orthopaedic Clinic: 713-792-6235
Sarcoma Clinic: 713-792-8850
The Orthopaedic Oncology department is located on the 10th floor of the T. Boone Pickens Academic Tower.
1400 Pressler Street
Houston, Texas 77030
University of Texas MD Anderson Cancer Center
P.O. Box 301402
Houston, Texas 77230-1402