Child cancer patient’s rotationplasty procedure a first for South Africa

A FIVE-YEAR-OLD bone cancer patient has been given a second lease on life after she underwent the country’s first rotationplasty procedure in

Cape Town.

The child, diagnosed with osteosarcoma (bone cancer) in her right femur, underwent the Van Ness rotationplasty procedure at the Life Vincent Pallotti Hospital at the hands of a super-specialised Life Orthopaedic Hospital team.

The Van Ness rotationplasty is a surgical procedure used to treat bone cancer of the lower limb where standard limb saving reconstructions are not possible.

The procedure consists of shortening of the leg with a rotation of 180 degrees of the lower leg which is adapted to the remaining upper leg bone (femur), changing the ankle function into a new knee joint.

Orthopaedic oncology and joint replacement surgeon, Dr Thomas Hilton, said: “The procedure provides patients with more function than a traditional amputation would, as the patient’s ankle acts as a substitute for the knee joint. It allows a prosthesis to fit more comfortably, providing better leg mobility and stability than patients who undergo a full high above knee amputation.”

Hilton met the 5-year-old patient, who had bone cancer in the lower part of the thigh bone (femur), when he travelled to Namibia for an orthopaedic oncology outreach programme in the Windhoek Central state hospital.

“Standard limb salvage procedures were not possible for the child due to the extent of the tumour and a Van Ness rotationplasty was deemed to be the best surgery for her,” he said.

He led the unique six-hour pro-bono procedure at Life Orthopeadic Hospital with support from Life Vincent Pallotti Hospital specialists and Dr Alma De Waal an anaesthetist from Groote Schuur Hospital.

“This is a great example of how public-private partnership can help patients,” he said.

Hilton explained that standard methods used mega-prosthetics or healthy bone tissue transfers with titanium plating systems. In a Van Ness rotationplasty the middle and lower section of the femur, including the knee, is removed along with the cancer and the lower shin (tibia), ankle and foot are then rotated 180 degrees and reattached to the remaining thigh or femur bone.

According to Hilton, a rotationplasty was more common in young children because they had so much growth remaining in their skeleton that standard prosthetics would leave them with a limb that would be too short to be useful. Most children recover well from rotationplasty and are more likely to adapt to the prosthesis because they are young and learn much faster than adults. They can usually resume activities such as running, ballet, climbing trees or playing soccer.

“I am truly privileged to be able to work with bone and soft tissue tumour/ sarcoma patients. They are some of the bravest patients in the world,” said Hilton.

Hospital manager, Gavin Pike said they were proud of the accomplishment.

CALLS are growing for Parliament to be in charge of oversight of the Ministerial Handbook and for transparency after “secret changes” were made, meaning taxpayers must pay for all the power and water bills for ministers and their deputies at official residences.

This week it emerged that President Cyril Ramaphosa had made changes to the handbook which had removed the R5 000 cap on utilities for members of the executive.

The cap had meant that only bills up to R5 000 had to be footed by the taxpayers and the excess was to be paid by the ministers and deputies but this had fallen away.

Civil society and opposition parties have slammed the move, saying millions of South Africans struggle to eke out a living while ministers earn in excess of R2 million a year.

The Office of the Public Protector has been asked to investigate the legality of such an amendment, although her office has yet to confirm receipt of the complaint.

But Minister in the Presidency Mondli Gungubele has defended the removal of the cap saying ministers should not be inconvenienced by having to pay for their own utilities.

In an interview, Gungubele said ministers were employed to work for government and the nature of their jobs, which he said were “24/7”, put them between Cape Town and Pretoria.

He said it would be unfair if ministers have to pay for everything for official homes for which they are appointed.

Build One South Africa (Bosa) leader Mmusi Maimane said ministers are no longer connected to communities. “There is an absence of values and a disconnect with the lived realities of people in the country.

“Equally, there are mayors who arrive in the fanciest German vehicles to talk to communities where there has not been any water.”

Maimane said the office of executive ethics in the Office of the Presidency was set up to monitor if perks are being abused.

“All the benefits are monitored by this body but it needs to raise issues of the abuse of executive privilege and even monitor gifts and benefits so Cabinet is never disconnected from the people.”

“Ministers and deputies do not see themselves as part of the people because they are immune from challenges with health care, education, water and the cost of living,” Maimane said.

“Being a minister comes with privileges, as in other countries, but there must be a value system and it must be policed.”

Political analyst Dr John Molepo, of the University of Mpumalanga, said state-owned houses occupied by ministers and their deputies, as set out in the ministerial handbook, are national key points and will be exempt from load shedding.

He said the country had a bloated Cabinet.

“If I were the president I would have cut Cabinet … if the government did this it would gain the confidence of the country's citizens.

“Ministers and Cabinet benefit themselves instead of broader society. This will have dire effects on how the ANC performs at the 2024 elections,” said Molepo.

“This is something that as a society we need to look into because citizens are losing trust in their leaders.

“Those approving this increase in perks … their critical and moral standing should tell them that this is too much.”

Molepo said South Africa should look at countries like China and compare executive perks.

The DA's Leon Schreiber said the party had submitted a formal complaint to the public protector after it had done research and found no legal precedent for the perks to be amended, and in a confidential manner.

Schreiber said the party was confident that they have a strong case.

“There is nothing in the Constitution, nothing in the PFMA (Public Finance Management Act), Executive Ethics code or any other legislation that empowers the president to decide that taxpayers have to pay more (for the executive) without consulting Parliament.”