Abstract
<jats:p>Rotationplasty is a biological limb-salvage procedure originally developed for tuberculosis and congenital femoral deficiency and later adopted in orthopedic oncology for malignant bone tumors around the knee. The technique involves a 180° rotation of the distal limb and fusion to the proximal femur, allowing the ankle joint to function as a neo-knee and enabling use of a below-knee prosthesis with highly efficient gait mechanics. Compared with transfemoral amputation or endoprosthetic reconstruction, rotationplasty offers important advantages, including durability during growth, a low revision burden, excellent energy efficiency, and high long-term patient satisfaction. Primary oncologic indications include high-grade malignant tumors of the distal femur (Winkelmann type A1), proximal tibia (A2), and selected cases requiring total femur resection (B3). Non-oncologic indications include severe congenital femoral deficiency. Absolute contraindications are loss of tibial nerve function, irreparable vascular compromise, and severe ankle stiffness, while psychosocial intolerance and limited survival prognosis are considered relative contraindications. Optimal outcomes depend on multidisciplinary preparation, including psychosocial counseling, growth prediction, and early prosthetic planning. Surgical technique emphasizes meticulous neurovascular preservation or reconstruction, perpendicular osteotomies, and controlled rotation guided by preoperative alignment markings. Fixation is most commonly achieved using locking plates, with adapted reconstructive strategies for total femur cases. Postoperative management includes vascular monitoring, early mobilization, and structured rehabilitation. Long-term results demonstrate excellent functional outcomes, high levels of physical activity, and superior gait efficiency compared with transfemoral amputation. When carefully selected and precisely executed, rotationplasty remains a durable and effective reconstructive option that preserves function and quality of life in young patients undergoing limb-sparing tumor surgery.</jats:p>