A rotationplasty is a unique surgical procedure used to reconstruct after resection of a tumor of the leg or a congenital defect. This procedure avoids phantom pain, limb length discrepancy and infections or implant related complications. The outcome is unusual for cosmesis but very functional.

Background: Borggreve first described a rotationplasty in Germany in 1930 for a 12 year old patient whose knee was destroyed by tuberculosis. In 1950 Van Nes modified the procedure. Kotz and Saltzer described in 1982 the use of a modified version of a rotationplasty to treat malignant tumors of the distal femur.

Case studies of two such patients will be presented.

A 27 year old man had a non-metastic osteosarcoma of his distal femur at the age of five. He underwent chemotherapy and a rotationplasty. Six years after his operation a correction osteotomy was done. He is doing very well physically and mentally. He graduated business studies, went yearly on Alpine skiing on two legs, likes jogging and perceives no limitations in his life (MSTS, TESS, SF-36).

Although is said that rotationplasty had a poor cosmesis and poor psychosocial acceptance, this is not our experience.

Purpose: Surgery is the only treatment option for chondrosarcoma grade I. Because this cartilage tumour is found by coincidence, patients feel unsafe, are anxious and very emotional. The purpose of this study was to evaluate the psychological and social impact of a chondrosarcoma grade I and to optimize the care of these patients.

Patients and methods: Eighty-two patients with a mean age of 50 years (22 – 80), who underwent surgery because of a chondrosarcoma grade I between 1990 and 2007, participated in this retrospective multi-method study. Assessment followed using, the Short Form-36, the MSTS and a special developed semi-structured questionnaire. The mean follow-up time was 4,8 year. 66 patients had a curettage, fenolisation and bonegraft. Sixteen patients had a resection. Five of them underwent a reconstruction with an allograft and another five a reconstruction with prosthesis.

Results: The majority of the patients (77%) were satisfied with our information. For mortgage and life/health insurance there were consequences in 18% of the patients. The SF-36 displayed slight lower scores in all domains except for mental health. Satisfaction with the operation is connected to emotional acceptance.

Conclusions: For patients afflicted by chondrosarcoma grade I the psychological impact is enormous. Three-quarter of the patients think often about the diagnosis and 40% was concerned about the waiting time before operation. To a lesser extent, patients were concerned about the impact of the chondrosarcoma on their lives. Within both domains, psychological as well social, there is a task for the nurse practitioner or a social worker in improving care of these patients. The extent of the surgical procedure does not influence patient satisfaction. The emotional acceptance of the disease decides the level of patient satisfaction.