Ankle becomes knee joint in bone cancer procedure



Posted on November 25, 2013 at 10:19 AM

AUSTIN, Texas -- Imagine a child suffering from bone cancer in the leg. Now imagine doctors removing the diseased portion and attaching the two healthy sections, effectively turning the ankle into the knee.

It's called Rotationplasty, and one Austin teen is helping put a face on the remarkable procedure.

Like a lot of 14-year-old girls, Zoe Croman likes horses.

"I love horseback riding," she said.

Zoe's time in the saddle had to take a back seat about a year ago when she couldn't shake intense pain in her right leg. Her doctor gave her the life changing news.

"He said, 'I really hate to tell you this and I hate my job, because I'm the one who has to tell you it is cancer,'" she said.

Zoe has osteosarcoma, one of the most common bone cancers in children.

"Hers was in the bottom half of the thigh above the knee," said Ron Williams, M.D., an orthopedic oncologist with Texas Oncology.

Williams is Zoe's orthopedic oncologist. He told her family they had three options, a full amputation at the hip, a limb salvage amputation just above the knee that may require numerous surgeries for the rest of her life or the oddest and least known procedure: Rotationplasty.  

That's where the cancerous portion of the knee or thigh is removed, and the healthy lower part of the leg is rotated and attached to the remaining leg or thigh. What had been the ankle became a knee joint. Williams, the only surgeon in Austin to perform the procedure, said Rotationplasty was Zoe's best option.

"As the doctor said, 'If you can get your wits around it it's a good option for her,'" said Stephanie Croman, Zoe's mother. "I thought that was well put."

"It's kind of nerve wracking to say, 'Yes you can talk off my leg, turn it around backwards and stick it back on,'" said Zoe.

Williams said the procedure not only affords Zoe the dexterity she would not have gotten with an above the hip amputation, but it also limits the amount of energy she needs to just get around.

"The amount of work it would take just to walk across the room for an amputation at the hip joint would be similar to someone running a sprint," said Williams.

That's energy Zoe would prefer spending at SunCrest Farm in Manor riding her horses. She and her family said they have no regrets about opting for Rotationplasty.

"We have zero doubt it was absolutely the right option for her," said Stephanie.

"Are you really going after an image of what you want your child to look like, or are you going after what they'll be able to do and accomplish with their lives?" said Russell Croman, Zoe's father.

"It's so phenomenal and wonderful," said Zoe. "I'm really glad I chose this."

Zoe said she understands why she gets strange looks and stares.

"I think that it's OK that they're curious, because it's unusual," she said. "It's not something you see every day. I like to think about it as kind of inspiring."  

Doctors said Zoe's strength and endurance will improve dramatically once she completes her chemotherapy in January, just in time for Zoe's birthday. She said completing her chemo will be the best present she can get.  

In addition to Dr. Williams and Texas Oncology, several other medical professionals play a role in performing the Rotationplasty procedure here in Central Texas.

Dr. Robert Whitfield of the Breast and Body Center of Austin is the plastic surgeon who performed the vascular reconstruction.

Dell Children's Medical Center created the infrastructure to allow this kind of complex problem to be handled in Austin. A big part of the cancer management is the pediatric oncologists at Dell who do the chemotherapy.

The Dell 4N Nursing Service are the specialists who work with Zoe during her chemotherapy.  Then there’s the pathologists, radiologists and prosthesis who play a behind the scenes, but major role as well.