Tibial rotation-plasty for proximal femoral focal deficiency

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Kritter-AE J-Bone-Joint-Surg-Am. 1977 Oct; 59(7): 927-34 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.