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.