Salvage of a Below Knee Amputation Utilizing Rotationplasty Principles in a Patient with Chronic Tibial Osteomyelitis

Chronic osteomyelitis is a disease that requires fastidious treatment to eliminate. However, when eradication is unable to be achieved through exhaustive modalities of antibiotic therapy and multiple debridements, significant resection of the infected bone and soft tissue must be considered, including amputation. Here we report of a salvage procedure for chronic osteomyelitis of the left tibia by employing a rotationplasty to avoid an above knee amputation and instead provide the patient with a below knee amputation.

A 51-year-old male presented to the emergency department after noticing dehiscence of an operative wound with exposure of an implant in the left lower extremity. Two years prior to presentation, the patient was involved in a motorcycle accident and underwent four surgeries in the Dominican Republic for an open fracture of the left tibia and fibula, including a procedure that involved the placement of an implant in the left proximal tibia. Tissue biopsies from the wound confirmed that the patient had osteomyelitis of the left proximal tibia. After extensive surgical and antibiotic intervention to eradicate the patient's osteomyeltis, it was eventually determined that an amputation would be necessary. In order to avoid an above knee amputation, a salvage procedure was conducted by employing a rotationplasty to provide the patient with a below knee amputation.

When amputation is deemed necessary, sparing the knee joint is associated with decreased energy expenditures, increased patient satisfaction and overall better postoperative outcomes. As part of a multi-disciplinary team, orthopaedics, plastic surgery, infectious disease, and medical services successfully treated this case of chronic osteomyelitis of the left proximal tibia by employing a rotationplasty to avoid an above knee amputation and achieve a below knee amputation.