Physis-sparing rotationplasty as a salvage procedure after failed allograft in paediatric osteosarcoma

Classic rotationplasty technique uses femoral and tibial osteotomies to resect portions of the distal femur and proximal tibia, most commonly in the setting of malignancy. The procedure involves rotating the lower extremity 180° to transform the ankle into a new hinge (knee) joint. This case describes an example of rotationplasty as a limb salvage option following a failed distal femoral reconstruction in a paediatric patient with osteosarcoma. Additionally, to reduce the likelihood of revision for malalignment, a tibial osteotomy was not performed, and the intramedullary nail was kept in a dynamically locked position, preserving the potential for growth through the proximal tibial physis in the rotated limb. This modification demonstrates that sacrificing the proximal tibial physis is not always necessary when performing rotationplasty, offering young patients both disease control and gradual growth of the operative limb with less importance on speculative growth calculations preoperatively.