Outcomes of type BIIIa rotationplasty in children

Total excision of the femur and its reconstruction pose a substantial challenge in children. We present the long-term results of total femoral excision and type BIIIa rotationplasty in children.

A total of 18 patients who had undergone a type BIIIa rotationplasty over a period of 20 years were included in the study. Their mean age at the time of surgery was 7.1 years (3.3 to 11). Two patients underwent a hip disarticulation in the perioperative period. Five died in the first two years from surgery. The mean follow-up of the remaining 11 patients was 124 months (24 to 244). We evaluated their long-term radiological, functional, and oncological outcomes and measured any limb length discrepancy at final follow-up.

The hip was stable in eight of 11 patients. Radiologically appreciable remodelling of the proximal tibia was seen in all patients. At final follow-up, four patients had reached skeletal maturity, five were adolescents (aged 12 to 17 years), and two were still pre-adolescent (aged < 12 years). The mean shortening in the skeletally mature patients was 2.25 cm (0 to 4). Limb length was measured in four of the five adolescent patients: the mean shortening was 0 cm (-1 to +1). Other than the two patients who underwent a hip disarticulation in the immediate perioperative period, no patient needed a subsequent surgical procedure. None of the patients had a local recurrence. The five-year probability of overall survival was 70% (95% CI 51 to 96). The mean Musculoskeletal Tumor Society score was 23 (22 to 23). The mean Toronto Extremity Salvage Score calculated in nine patients was 91 (82 to 100).

A type BIIIa rotationplasty is a reliable option for reconstruction after total femoral excision in children. Long-term follow-up shows good functional and oncological outcomes, without the need for additional surgical procedures.