We shall not fail or falter; we shall not weaken or tire. Neither the sudden shock of battle nor the long-drawn trials of vigilance and exertion will wear us down. Give us the tools and we will finish the job.
Sir Winston Churchill
What factors should we consider before making a decision concerning rotationplasty?
The age of the child, the size and location of the cancer, medical prognosis, functional outcomes desired, and the wishes of the patient and family.
Has there ever been research comparing rotationplasty to limb-spare?
Hillmann et al compared limb sparing with an endoprosthetic replacement and rotationplasty in treatment of malignant tumors of the lower extremity and reported quality of life self-assessed by the patients. The patients were between the ages of eleven and twenty-four at time of diagnosis, with thirty-three patients receiving rotationplasty and thirty-four patients receiving endoprosthetic replacement. Results revealed that quality of life was enhanced in those patients who had rotationplasty, including an increased ability to participate in hobbies such as sports, as well as fewer restrictions in activities of daily living due to pain.
Akahane et al evaluated functional outcomes and quality of life in 22 patients one year after the three different surgical procedures, limb-sparing, rotationplasty or amputation. When compared with amputation and prosthetic reconstruction, rotationplasty was shown to produce significantly higher functional scores on the Musculoskeletal Tumor Society assessment, MSST and health related quality of life assessment.
In another study looking at patients undergoing rotationplasty, Hillmann et al analyzed muscle activity and gait to determine how these were associated with functional outcomes. Forty-three patients who underwent rotationplasty were studied with the mean follow up six years. Gait analysis revealed a fairly normal walking pattern with a slight lateral lean over the trunk of the limb with the rotationplasty in 68% of patients. Electromyography studies revealed function of muscles in the involved limb to be similar amplitudes as the uninvolved limb. The patients showed good functional outcomes as demonstrated by a high functional score, as well as restoration of gait with minimal deviations in the majority of subjects.
To get the ball rolling since the website is new, here are a few questions Sean Dever's parents where asked about Sean and his rotationplasty experience.
1) How soon was it after Sean's rotationplasty that he was fitted with a prosthetic? Two months later with a "trainer" leg in December 2007. Another leg in April 2008 and a better more efficient leg in August 2008. Leg a year later July 2009, April 2010, and January 2011.
2) How does Sean deal emotionally with the rotationplasty, early on and now? He has been fine from very early on. He actually told us that this was the operation he wanted. We were leaning that way as well and it was important for him to have a say.
3) How did this decision impact Sean's school life/social life/friendship group? (from Sean - more friends after operation, everything else has been OK) We have such a great community and we have never seen any ill effects as of now. I don’t know what the future will be like though- but we are very open and stand tall always.
4) What company do you use for Sean's prosthetic leg? Steven Miller, who has rotationplasty himself, is out of Savannah and works with Hanger.
5) How did Sean get around until he got his prosthetic leg? crutches, wheelchair, both? Wheelchair for about two weeks and then clutches. Crutches after October operation until April. He walked without crutches in between on occasion.
6) Is Sean comfortable with his prosthetic leg off around his friends, or out in public? With his friends he is very comfortable. (Sean - Yes, I was at school for so long without a leg so it is no big deal. Not in public, no.)
7) Did you consider just a straight amputation for Sean? No, I thought either rotationplasty or limb salvage. I was terrified of phantom pain – don’t know if that is nuts or not. I never really researched it though - just was scared of it for him. After doing some research now, I believe that rotationplasty or amputation is a way to up the percentage in living cancer-free.
8) Why did you use Dr. Scarborough? Was he recommended to you? Dr. Scarborough had done the most rotationplasties in the US, sans a doctor at the Mayo Clinic. He operated on a little boy here in Atlanta and a few others we had heard about.
9) Did you have to travel back to Dr. Scarborough for any post-surgery followup? or did a local orthopedic surgeon help with the follow up, like stitches removal, etc.. Both actually. We went back down to Fl twice, six weeks out and then about 7 months out. We have a great orthopedic guy here who took out his stitches and consulted with Scarborough when Sean had fallen - x-rays were taken but all was OK. The surgeon here also worked with our PT to discuss Sean's abilities and care.
10) Did you get to meet someone who has had rotationplasty BEFORE Sean's Surgery? Yes. Google "cancer was the easy part." Monte and his mom came to visit us after leaving Savannah. They were wonderful and answered all of our questions.