Communication Affichée: Best of poster

Le 15/10/2021 de 09:00 à 10:30

Retour Session


L'ostéoplastie de retournement tibial selon Van Nes en oncologie pédiatrie : un changement de paradigme ?

Laurie Ellias (Toulouse, France), Antoine Cordival (Toulouse, France), Marie Nolla (Toulouse, France), Virgile Pinelli (Toulouse, France)

Objective : Pediatric bone cancers are rare but disabling. Conservative surgery is not always possible. If the tumor is near the knee, type A Van-Nes rotation-osteoplasty (A/VNRO) allows to use ankle as a neo-knee. Thus, the patient use transtibial prosthetis instead of transfemoral. This study aim is to look if this 70 years old surgery is still topical in 2021.

Material / Patients and Methods : We made a scoping review using Pubmed and Scopus databases with keywords “rotationplasty”, “child”, and “rehabilitation”. Articles older than 2000 were excluded. From 57 results, we included only 9 articles (figure 1).

Results : The most frequent outcomes concerned function, quality of life and musculoskeletal complications, with 2,8 to 33 years follow-up.
Seven studies were comparative, including one comparing A/VNRO versus transfemoral prosthesis with mechanical knee.
Patients treated with A/VNRO keep high activity level on MSTS and TESS questionnary. Pain is absent, mild, or moderate. There is no significant increase of psychological troubles. Gait, walking pattern and speed are satisfying on regular field. Over uneven terrain, A/VNRO leads to walking difficulties and falling risk.
Musculoskeletal complications are lead by precocious hip arthrosis and operated limb osteopenia.

Discussion - Conclusion : Despite A/VNRO is a functionally efficient surgery, there is no comparison with recent microprocessor controlled knees (MPC-K). If A/VNRO was functionally equivalent to mechanical knees, it could be hypothesized that MPC-K overcomes it.
Also in 2021 A/VNRO should be obsolete. The place of type B VNRO, to avoid hip disarticulation considering MPC-K should be studied.

Keywords : rotationplasty child oncology rehabilitation