Long-term follow-up of Van Nes rotationplasty in patients with congenital proximal focal femoral deficiency

J. Ackman, H. Altiok, A. Flanagan, M. Peer, A. Graf, J. Krzak, S. Hassani, D. Eastwood, G. F. Harris


Van Nes rotationplasty may be used for patients with congenital proximal focal femoral deficiency (PFFD). The lower limb is rotated to use the ankle and foot as a functional knee joint within a prosthesis. A small series of cases was investigated to determine the long-term outcome. At a mean of 21.5 years (11 to 45) after their rotationplasty, a total of 12 prosthetic patients completed the Short-Form (SF)-36, Faces Pain Scale-Revised, Harris hip score, Oswestry back pain score and Prosthetic Evaluation Questionnaires, as did 12 age- and gender-matched normal control participants. A physical examination and gait analysis, computerised dynamic posturography (CDP), and timed ‘Up & Go’ testing was also completed. Wilcoxon Signed rank test was used to compare each PFFD patient with a matched control participant with false discovery rate of 5%.

There were no differences between the groups in overall health and well-being on the SF-36. Significant differences were seen in gait parameters in the PFFD group. Using CDP, the PFFD group had reduced symmetry in stance, and reduced end point and maximum excursions.

Patients who had undergone Van Nes rotationplasty had a high level of function and quality of life at long-term follow-up, but presented with significant differences in gait and posture compared with the control group.

Cite this article: Bone Joint J 2013;95-B:192–8.


  • This project was funded by the Helen Kay Charitable Private Foundation. The authors would also like to acknowledge the assistance of Kathy Reiners and Vickie Young in the Motion Analysis Lab at Shriners Hospitals for Children; and Scheck & Siress and Bardach & Schoene prosthetic laboratories.

    No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

  • Supplementary material. A table detailing the results of the Prosthetic Evaluation Questionnaire for individuals who had a Van Nes rotationplasty is available with the electronic version of this article on our website www.bjj.boneandjoint.org.uk

  • Received September 10, 2012.
  • Accepted October 16, 2012.
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