The human form: Accepting the prioritization of patient values

A seventeen-year-old boy who had had a subtotal femoral reconstruction because of an osteosarcoma in the left femur, and a subsequent revision for hardware failure, was again having severe pain secondary to failure of the endoprosthesis. The patient's original orthopaedic oncologist, who had performed both previous operations, recommended that the patient have an above-the-knee amputation. The patient and his parents inquired about the Van Nes rotationplasty. They were told directly that it was an antiquated procedure that was not done anymore. The prosthetist with whom they were working gave them the name of an orthopaedic oncologist who could perform the Van Nes procedure. They traveled 850 miles for a consultation, and the patient underwent the procedure. Several months after the operation, the patient walked with a slight limp and looked like a perfectly normal teen-ager in a pair of jeans. On examination, he had a well-fitted below-the-knee prosthesis attached to his foot, which was in nearly 160° of what was essentially plantar flexion, perfectly matching the attitude of a knee as it couples to a below-the-knee prosthesis. The boy and his parents, who had decided months earlier to opt for an uncommonly performed procedure that would give him a chance at a "normal" appearing and functioning limb, deemed the surgery a complete success with an "excellent" outcome.