Factors Affecting Surgical Outcomes Following Rotationplasty in Paediatric Sarcoma: A Literature Review

Rotationplasty is a functionally robust limb-salvage procedure for paediatric lower-limb sarcoma patients, in which the ankle assumes the functional role of the knee within a prosthesis. Despite favourable long-term outcomes, the procedure is infrequently performed, and systematic evaluation of the surgical and perioperative factors influencing its success remains limited. This narrative review aimed to: (1) identify the surgical and perioperative factors that influence complications and functional outcomes, including rotationplasty type, incision design, vascular management, nerve preservation, and fixation method; (2) characterise the scope of outcome reporting across functional, psychosocial, and oncologic domains; and (3) define gaps to inform future rotationplasty research and decision-making. Fifty-eight studies were identified, falling into two distinct streams. The first (n = 14) examined specific surgical or perioperative factors, including rotationplasty type, incision design, vascular management, nerve preservation, and fixation methods, each associated with distinct complication profiles. The second (n = 44) provided broader outcome data, describing rotationplasty without analysing specific intraoperative variables, often in comparison to other procedures. These papers provided a scope of significant outcomes across literature, including vascular compromise, wound healing, and nerve palsy. Long-term functional, psychosocial, and quality of life findings were shown to be overall favourable, often surpassing results following amputation or endoprosthetic reconstruction. The evidence base is constrained by retrospective designs, small sample sizes, mixed-age cohorts, and inconsistent outcome reporting, limiting technique-specific conclusions. Prospective, age-stratified studies with standardised perioperative, functional, and psychosocial outcome measures are needed to better define the relationship between surgical technique and outcome in paediatric rotationplasty.