1. by Winfried W. Winkelmann
Type-B-IIIa Hip Rotationplasty: An Alternative Operation for the Treatment of Malignant Tumors of the Femur in Early Childhood*
by Winfried W. Winkelmann
J Bone Joint Surg Am
Volume 82(6):
June 1, 2000
©2000 by The Journal of Bone and Joint Surgery, Inc.

2. Figs. 1-A through 1-G: Drawings illustrating the steps of the type-B-IIIa hip rotationplasty (see text for details).Fig. 1-A: The incisions are made with the patient positioned on the unaffected side.
Figs. 1-A through 1-G: Drawings illustrating the steps of the type-B-IIIa hip rotationplasty (see text for details).Fig. 1-A: The incisions are made with the patient positioned on the unaffected side.
Winfried W. Winkelmann J Bone Joint Surg Am 2000;82:814
©2000 by The Journal of Bone and Joint Surgery, Inc.

3. The proximal part of the operation is similar to a hip disarticulation.
Winfried W. Winkelmann J Bone Joint Surg Am 2000;82:814
©2000 by The Journal of Bone and Joint Surgery, Inc.

4. The distal part of the operation is similar to a knee disarticulation.
Winfried W. Winkelmann J Bone Joint Surg Am 2000;82:814
©2000 by The Journal of Bone and Joint Surgery, Inc.

5. After the leg is rotated 180 degrees, the lateral aspect of the proximal part of the tibia is placed into the acetabulum and fixed in position.
After the leg is rotated 180 degrees, the lateral aspect of the proximal part of the tibia is placed into the acetabulum and fixed in position.
Winfried W. Winkelmann J Bone Joint Surg Am 2000;82:814
©2000 by The Journal of Bone and Joint Surgery, Inc.

6. The medial and lateral heads of the gastrocnemius and the tendons of the rotators are attached to the hip capsule, and the tendon of the iliopsoas muscle is attached to the tibial periosteum.
The medial and lateral heads of the gastrocnemius and the tendons of the rotators are attached to the hip capsule, and the tendon of the iliopsoas muscle is attached to the tibial periosteum.
Winfried W. Winkelmann J Bone Joint Surg Am 2000;82:814
©2000 by The Journal of Bone and Joint Surgery, Inc.

7. The femoral artery and vein are anastomosed to the popliteal artery and vein, the adductor muscles are reattached to the tibial periosteum and fasciae, the tendons of the gluteus medius and minimus are fixed to the tibial periosteum and attached to the caps...
The femoral artery and vein are anastomosed to the popliteal artery and vein, the adductor muscles are reattached to the tibial periosteum and fasciae, the tendons of the gluteus medius and minimus are fixed to the tibial periosteum and attached to the capsule, and the gluteus maximus muscle is attached along the tibial periosteum.
Winfried W. Winkelmann J Bone Joint Surg Am 2000;82:814
©2000 by The Journal of Bone and Joint Surgery, Inc.

8. The overlapping skin edges are excised with the greater part of the skin taken from the distal flap.
Winfried W. Winkelmann J Bone Joint Surg Am 2000;82:814
©2000 by The Journal of Bone and Joint Surgery, Inc.

9. Figs. 2-A and 2-B: Case 6.
Figs. 2-A and 2-B: Case 6. Photographs showing the functional outcome and sports activity of a nine-year-old girl five years following a rotationplasty.Fig. 2-A: The patient is shown performing range-of-motion exercises for the hip and knee as well as weight-bearing activities while wearing the final prosthesis.
Winfried W. Winkelmann J Bone Joint Surg Am 2000;82:814
©2000 by The Journal of Bone and Joint Surgery, Inc.

10. The patient is shown jumping over a hurdle.
Winfried W. Winkelmann J Bone Joint Surg Am 2000;82:814
©2000 by The Journal of Bone and Joint Surgery, Inc.

11. Figs. 3-A through 3-D: Case 2.
Figs. 3-A through 3-D: Case 2. Radiographs showing sequential changes that led to conversion of the lateral aspect of the proximal part of the tibia into a new femoral head over a seven-year period.Fig. 3-A: Five weeks postoperatively, there is atrophy due to inactivity of the proximal part of the tibia. The medial part of the tibia is not well centered in the acetabulum.
Winfried W. Winkelmann J Bone Joint Surg Am 2000;82:814
©2000 by The Journal of Bone and Joint Surgery, Inc.

12. Fig. 3-B: Three years and four months postoperatively, there are signs of remodeling, with formation of a partial femoral head and acetabulum.
Fig. 3-B: Three years and four months postoperatively, there are signs of remodeling, with formation of a partial femoral head and acetabulum.
Winfried W. Winkelmann J Bone Joint Surg Am 2000;82:814
©2000 by The Journal of Bone and Joint Surgery, Inc.

13. Fig. 3-C: Six years and ten months postoperatively, there is increasing centering of the femoral head, which is starting to have a more normal appearance.
Fig. 3-C: Six years and ten months postoperatively, there is increasing centering of the femoral head, which is starting to have a more normal appearance. The medial part of the tibial physeal plate is oriented toward the vector of force. There is appositional bone growth on the medial side of the proximal part of the tibia, and the compressive trabeculae are merging into the thickened tibial cortex.
Winfried W. Winkelmann J Bone Joint Surg Am 2000;82:814
©2000 by The Journal of Bone and Joint Surgery, Inc.

14. Fig. 3-D: The contralateral hip is shown for comparison.
Winfried W. Winkelmann J Bone Joint Surg Am 2000;82:814
©2000 by The Journal of Bone and Joint Surgery, Inc.

15. Figs. 4-A and 4-B: Case 6.
Figs. 4-A and 4-B: Case 6. Magnetic resonance imaging scans showing the newly formed lateral aspect of the femoral head five years and nine months after rotationplasty.Fig. 4-A: Three sections from the axial T2-weighted fast-spin-echo sequence showing good centering of the newly formed femoral head within the acetabulum. The thick cartilage covering can be seen.
Winfried W. Winkelmann J Bone Joint Surg Am 2000;82:814
©2000 by The Journal of Bone and Joint Surgery, Inc.

16. Three sections from the coronal T1-weighted fast spin-echo sequence showing the thick cartilage covering the newly formed femoral head that conforms with the acetabulum.
Three sections from the coronal T1-weighted fast spin-echo sequence showing the thick cartilage covering the newly formed femoral head that conforms with the acetabulum. The gluteus muscles are attached to the newly developed greater trochanter.
Winfried W. Winkelmann J Bone Joint Surg Am 2000;82:814
©2000 by The Journal of Bone and Joint Surgery, Inc.