Medical Oncologist
CION Cancer Clinics
Rotationplasty explained | CION Cancer Clinics
Rotationplasty is an operation for a bone tumour around the knee. The surgeon removes the knee, turns the lower leg round and joins it to the thigh, so the ankle bends an artificial limb like a knee. It gives strong control and lets the foot feel the ground. The leg looks unusual, and it cannot be undone. This page explains how it works, who it suits and what to ask. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is rotationplasty?
- What happens during the operation?
- Who is rotationplasty usually considered for?
- What does recovery look like, stage by stage?
- What do families believe about rotationplasty?
- How does it compare with an above-knee amputation?
- How do you decide, and what should you ask?
- Common questions about rotationplasty
The short answer
What is rotationplasty?
Rotationplasty is an operation for a bone tumour around the knee. The surgeon removes the knee and the tumour, turns the lower leg round and joins it to the thigh, so that your ankle works as a new knee inside an artificial limb.
Why anyone would choose it
Because the foot is turned backwards and raised to knee height, the ankle can bend and straighten a prosthesis much like a knee does. That gives far more control than an above-knee amputation, where the artificial knee has no muscle of its own. The foot still feels touch, so the person senses the ground through the limb. Many people who have had it go on to run, cycle and play sport.
Why it is not offered more often
The leg looks very unusual afterwards, with the foot facing backwards at the level of the other knee. For some families that is hard to accept, and it is a fair thing to struggle with. It is a big decision that cannot be undone, and it needs time, photographs, and ideally a conversation with a physiotherapist who has worked with people after this operation.
This page explains the operation. It cannot tell you whether it suits you or your child. Only the surgical team, with the scans and biopsy in front of them, can weigh that.In the operating theatre
What happens during the operation?
The tumour is removed
The surgeon takes out the lower thigh bone, the knee and the upper shin bone, along with the tumour and a rim of healthy tissue. The main nerve to the lower leg is carefully kept.
The lower leg is turned
The lower leg and foot are rotated so the foot points backwards. This turns the ankle into a joint that bends in the same direction as a knee.
The bones are joined
The shin bone is fixed to the thigh bone with a metal plate and screws. The length is planned so that the ankle ends up level with the knee on the other side.
Blood vessels and muscles
The blood vessels are joined or looped, and the muscles are reattached so the ankle can move the new limb. The team checks the foot's blood supply closely in the first days.
Not sure whether this applies to you?
Ask an oncologistWho it is for
Who is rotationplasty usually considered for?
These are the situations in which a surgeon may raise it. None of them means it is right for you.
Young children still growing
A metal knee would need many lengthening operations as a child grows. The rotated leg grows with the child, so fewer operations are needed over the years.
Active teenagers and young adults
People who want to run, jump and play sport may value the strength and control of an ankle working as a knee.
They also have the longest life ahead with the leg's appearance, which deserves equal weight.When other options have run out
It may be raised after a metal knee has failed or become infected, or when too little bone and muscle remain for another repair.
Who it does not suit
It is not possible if the tumour involves the main nerve to the foot, or if the foot and ankle are not healthy.
It may also not fit
- Someone who cannot accept how the leg will look
- Tumours that are not near the knee
The road back
What does recovery look like, stage by stage?
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In hospital
The foot's colour, warmth and feeling are checked often. Pain relief, drains and the wound come first, and a physiotherapist starts gentle ankle movement.
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Going home on crutches
You walk with crutches while the bones join. If chemotherapy is needed, it usually continues during this stage.
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The first artificial limb
Once the bones have joined and the swelling has settled, a prosthetist makes a limb that the foot fits into. The ankle then bends and straightens it like a knee.
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Learning to use it
Walking training takes patience and regular physiotherapy. Most of the work is strengthening the calf muscles, which now do the job of the thigh muscles.
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Growing up with it
Children need new limbs as they grow, and follow-up continues for years, both for the leg and to watch for the tumour coming back.
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Commonly believed
What do families believe about rotationplasty?
"It is an old operation that nobody does now."
It has been done for a long time, but bone tumour surgeons still use it today for carefully chosen patients. Its age is not a reason to dismiss it.
"With the foot turned round, my child will not walk properly."
With an artificial limb and training, many children walk without a limp that others notice, and many play sport. The limb covers the foot, so in clothes the leg looks much like any other artificial leg.
"It is just an amputation with extra steps."
The difference is the working ankle. It moves the limb with your own muscles and still feels the ground, which an above-knee amputation cannot offer.
"We should decide quickly so the cancer does not spread."
Chemotherapy is often given before surgery, which usually leaves time to think. Ask the team how long you have to decide, and use it.
Side by side
How does it compare with an above-knee amputation?
Rotationplasty
Above-knee amputation
Your own ankle moves the artificial knee
The artificial knee has no muscle control of its own
The foot still feels the ground through the limb
No feeling below the stump
The leg looks unusual without the limb on
A shorter thigh, which families often find easier to accept
A longer, more complex operation
A shorter operation
Grows with a child's leg
The limb is changed as the child grows
Making the decision
How do you decide, and what should you ask?
This is one of the few cancer operations where how a family feels about the result carries as much weight as the medical details. Take the time the team gives you. It is reasonable to ask for a second meeting.
Talk it through with the child
Older children and teenagers should be part of the conversation, in words that suit their age. A child who understands why the foot is turned round often copes better than one who wakes up to it. Counsellors and physiotherapists can help you find the words.
Questions to take to the surgeon
Ask how many of these operations the team has done, and who will fit and adjust the artificial limb over the years. Ask what the other options are for this tumour, what each would mean for walking and school, and how many further operations each is likely to need. Ask what happens if the blood supply to the foot fails after surgery.
Ask to see what it looks like
Photographs of the leg with and without the limb help families decide honestly. Seeing them before the operation is much easier than seeing the leg for the first time afterwards.
Questions we are asked
Common questions about rotationplasty
Does the foot still feel things after rotationplasty?
Yes, in most cases. The main nerve to the foot is kept during the operation, so the foot still feels touch, warmth and pressure. This is one of the main benefits, because it lets the person feel the ground through the artificial limb. If the nerve cannot be kept safely, the operation is usually not possible.
Will my child be able to play sport?
Many people who have had rotationplasty take part in running, cycling, swimming and team games, because the ankle gives strong control of the limb. How far any one child gets depends on healing, chemotherapy, training and determination. The physiotherapist can tell you what is realistic as recovery goes on.
Can the foot be turned back later?
No. Rotationplasty cannot be reversed. If it later causes serious problems, the usual next step would be a different operation, not undoing this one. That is why the decision deserves time, photographs and more than one conversation with the team before surgery.
What can go wrong after the operation?
The main concerns are problems with the blood supply to the foot, infection, the bones not joining, and nerve problems in the foot. Some need another operation. Ask your surgeon how often they see each of these, and what they would do if one happened.
How will the leg look at school?
With trousers on and the limb fitted, the leg looks much like any other artificial leg. Without the limb, the backwards foot at knee height is noticeable. Some children are open about it, others prefer privacy. A counsellor and the school can help plan how to explain it to classmates.
Does rotationplasty change the chance of the cancer coming back?
The type of reconstruction is chosen after the team has planned how to remove the tumour with a clear margin. What matters for the cancer is how completely it is removed and how it responds to chemotherapy, not whether the leg is rebuilt this way or another way. Ask your team about your own situation.
Is rotationplasty done for adults?
It is most often discussed for children, but adults can have it too, especially active adults or when another repair has failed. An adult's ankle and calf muscles need to be strong enough to control the limb. Your surgeon and physiotherapist will judge this.
Is it covered by Aarogyasri or insurance?
Surgery for a bone tumour is usually covered when it is part of an approved cancer treatment plan. Aarogyasri, CGHS, ECHS, EHS and cashless insurers each have rules on artificial limbs and follow-up. Call the helpline with your card details and we will help you check your cover.
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Sources
- American Cancer Society — Surgery for osteosarcoma
- Cancer Research UK — Bone cancer
- Cancer.Net — Osteosarcoma - Childhood and Adolescence
- National Cancer Institute — Bone cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Limb Salvage or Amputation: How the Choice Is MadeWhat the team weighs before choosing an operationGrowing Prostheses for ChildrenThe metal alternative for a growing childAmputation in Children and School LifeHelping a child back into schoolGetting Fitted for a ProsthesisWhat the limb fitting involves
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