180° From Ordinary

Rare surgery helps young cancer patient take a turn for the better

Wyatt OshelWyatt Oshel is a fun-loving, big-hearted 6-year-old who never stops smiling. When strangers ask about his backwards foot, he states the facts: “I had cancer in my knee. So, they took part of my leg off and put my ankle where my knee was and put it on backward!”

It sounds different. Looks different. Is different. But this extraordinary procedure lets children like Wyatt live a surprisingly normal life. 

Discovery 

In January 2017, Wyatt’s dad, Brad, and older brother, Garrett, were practicing wrestling holds in the living room when Wyatt got a little too close to the action. He received an accidental kick to the knee. 

“Wyatt complained about soreness for a couple days, so we went to our pediatrician in Wellsville,” said his mom, Rebecca. “We were shocked when she said it could be cancer.” 

Expert help 

Rebecca and Brad took Wyatt to an oncologist in Kansas City. He ordered an MRI and referred the family to Howard G. Rosenthal, MD, orthopedic oncology surgeon and sarcoma specialist at The University of Kansas Cancer Center. 

After performing various imaging studies, Dr. Rosenthal performed a biopsy, obtained the results and made his diagnosis: Wyatt had a malignant bone cancer called osteosarcoma. 

Treatment plan 

The standard protocol for osteosarcoma includes chemotherapy to shrink the tumor, followed by surgery to remove the malignant bone and any tissue the cancer touches. Wyatt began chemo right away at Children’s Mercy Hospital, and Dr. Rosenthal began educating his parents about innovative limb-preservation procedures.

Rebecca and Brad learned more about amputation and implants than they ever thought possible. However, Dr. Rosenthal felt there was only one choice for a young osteosarcoma patient who still had a lot of growing to do. 

Rotationplasty to the rescue 

Rotationplasty is a double-level amputation technique that replaces the patient’s diseased knee joint with their own healthy ankle and foot. It gives the patient excellent function. More importantly, it spares a child from multiple surgeries to prevent discrepancies in limb length. 

Dr. Rosenthal can perform a rotationplasty in just four hours. First, he amputates above the tumor, through the thighbone. Then, below the knee, through the shinbone. The cancerous segment of the leg is removed, but the blood vessels and nerves that connect the thigh to the ankle are preserved. The ankle joint is then rotated 180 degrees and reattached. 

The ankle serves as the new knee. The foot becomes the new shin. The toes provide power. 

The ankle (or new knee) is placed where the other knee will be at skeletal maturity, so that when Wyatt is finished growing, his new knee will be at the same level as his contralateral knee. 

Wyatt’s dad summed it up, “With rotationplasty, Wyatt would need only one surgery. He would have no phantom pain. He would have unlimited mobility. We went from thinking ‘This is crazy’ to ‘Wow, this is awesome!’” 

Go-time On 

April 19, Rebecca, Brad and Dr. Rosenthal joined hands in prayer before Wyatt was wheeled into surgery. Dr. Rosenthal sent texts to the family during the four-hour procedure to let them know it was going well. As soon as Wyatt woke, he wiggled his toes. Within two days, he had learned to flex his new knee and think of his foot as his shin. 

A new normal

Today, Wyatt’s sarcoma is gone. He has a cool-looking prosthesis he slips off and on like a sock. With the prosthesis off, Wyatt can hop, scoot, walk and swim. With the prosthesis on, Wyatt will eventually be able to run, ride his bike and play soccer. 

Brad said he feels extremely lucky. “There are only a handful of surgeons in the country who do this surgery, and we have one of the best right here — an hour from our home town,” he said.


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