A seventeen-year-old boy who had had a subtotal femoral reconstruction
because of an osteosarcoma in the left femur, and a subsequent revision for
hardware failure, was again having severe pain secondary to failure of the
endoprosthesis. The patient's original orthopaedic oncologist, who had
performed both previous operations, recommended that the patient have an
above-the-knee amputation. The patient and his parents inquired about the Van
Nes rotationplasty. They were told directly that it was an antiquated
procedure that was not done anymore. The prosthetist with whom they were
working gave them the name of an orthopaedic oncologist who could perform the
Van Nes procedure. They traveled 850 miles for a consultation, and the patient
underwent the procedure.
Several months after the operation, the patient walked with a slight limp
and looked like a perfectly normal teenager in a pair of jeans. On
examination, he had a well-fitted below-the-knee prosthesis attached to his
foot, which was in nearly 160° of what was essentially plantar flexion,
perfectly matching the attitude of a knee as it couples to a below-the-knee
prosthesis. The boy and his parents, who had decided months earlier to opt for
an uncommonly performed procedure that would give him a chance at a
"normal" appearing and functioning limb, deemed the surgery a
complete success with an "excellent" outcome.