Rotation plasty for osteosarcoma of the femur

A 20-year-old female with right femoral osteosarcoma noted severe pain and swelling of the right thigh, and was transferred to the authors' hospital after suffering a pathologic fracture of the right femur. Plain x-ray disclosed a tumor shadow extending from the pathologic fracture of the distal portion of the femur to the center of the diaphysis. MRIs showed a broad lesion and hematoma, and invasion to the femoral vascular bundle was suspected. Angiograms revealed vascularization coincidental to the tumor, and an irregular vascular wall of the femoral artery, which was shifted posteriorly. After consultation with the patient and her family, rotation plasty was performed. The sciatic nerve was isolated and preserved; major vessels were sectioned proximally and distally because of tumor tissue invasion to the femoral artery and vein. After wide excision of the tumor, the leg was rotated outward 180 degrees, and osteosynthesis was performed between the remaining femur and the tibia, followed by microsurgical anastomosis of vessels. Five years postoperatively, no local recurrence or metastasis has been observed. The patient has excellent functional recovery without pain, and no other complications.