The Journal of Bone and Joint Surgery, Vol 59, Issue 7 927-934, Copyright © 1977 by Journal of Bone and Joint Surgery, Inc
Tibial rotation-plasty for proximal femoral focal deficiency
AE Kritter
The most common treatment for proximal femoral focal deficiency is
amputation at the level of the ankle joint and subsequent prosthetic
fitting in the manner used for an above-the-knee amputee. Since 1967, five
patients with proximal femoral focal deficiency were treated with the Van
Nes procedure -- an 180-degree tibial rotation-plasty to convert the ankle
joint to a knee joint. Two of the five patients had excellent results --
the tibial rotation-plasty allowed the ankle joint to function as a knee
joint with 90 degrees of flexion and placed it at the level of the
contralateral anatomical knee. Fusion of the anatomical knee above the
tibial rotation-plasty in these two patients provided a stable tibiofemoral
lever arm that functioned as the thigh. Two patients had good results --
satisfactory functional and cosmetic improvement. In the remaining patient,
who had associated paraxial fibular hemimelia with absence of the fourth
and fifth rays of the foot, the result was a failure.