A Story of Cancer, Rotationplasty—and Friendship

It started off as just an ordinary day on 4 West—the cancer floor at Children’s Hospital Los Angeles. And in his room, 9-year-old Noah was getting restless.

“It was very fortuitous because we didn’t normally go to the playroom,” says his dad, Darryl. “But on this one day, he really wanted to go.”

It’s a good thing they went, too. Because that’s how Noah and Wallie met.

A meeting in the playroom

The families noticed each other right away. Wallie was already in the playroom with his dad, Clement, playing a video game. Like Noah, Wallie was in a wheelchair and hooked to an IV that was delivering chemotherapy. And like Noah, one of his legs was clearly swollen.

It didn’t take long to learn that the two boys were not only close in age, but they also had the same cancer: osteosarcoma, an aggressive bone tumor not usually seen in kids that young.

The parents went out in the hallway to talk. But while the adults were connecting over their pain and worry, Wallie and Noah were bonding over something else: fun.

By the time their families returned, the two boys were deep into a thrilling Super Smash Bros. battle.

“They just clicked,” Clement says. “For that moment, they weren’t going through chemo anymore. They were just two kids laughing and playing Nintendo Switch.”

A rare cancer, but not here

Wallie—a high-spirited kid who loves soccer and dogs and making people laugh—was initially treated at another hospital. But his parents soon transferred his care to CHLA.

“I can’t rave enough about Children’s Hospital Los Angeles,” says Wallie’s mom, Jeanne. “The doctors, nurses, and staff are wonderful. And the hospital is such a cheerful place. Wallie was much more relaxed there, and we were too.”

Noah, meanwhile, loves swimming and is playful and funny. He is quieter than Wallie—at least until he gets to know you. From the beginning, he was treated at CHLA, which is ranked No. 6 in the nation in kids’ cancer care by U.S. News & World Report.

“These tumors are rare in the world, but at CHLA, we see them all the time,” says Fariba Navid, MD, Wallie’s oncologist and Medical Director of Clinical Research in the Cancer and Blood Disease Institute. “We have a large, multidisciplinary team that focuses on bone tumors, and we work closely together on every case.”

That experience is especially important for a cancer like osteosarcoma. Wallie and Noah faced a tough treatment course—with three months of chemotherapy, a surgery, and then six more months of chemo.

The most difficult decision facing each family was the surgery. Both Wallie and Noah would need a procedure so rare that most orthopedic oncologists never perform one in their entire careers.

A backwards leg?

Typically, patients with osteosarcoma receive an implantable endoprosthesis, or metal rod, to replace the cancerous bone that is removed. They lose the ability to do high-impact sports, but on the outside, their leg looks normal.

But Wallie and Noah were much younger than the typical teenage osteosarcoma patient. And their cases presented other challenges.

“Wallie’s tumor was extremely large,” explains Alexander Christ, MD, an orthopedic oncologist in the Jackie and Gene Autry Orthopedic Center at CHLA—ranked No. 4 in the country for pediatric orthopedic care by U.S. News & World Report. “He would have needed a total femur replacement, which has very low function.”

Both boys also would have needed at least six additional surgeries, if not more, to adjust the metal rod as they grew.

Expandable endoprostheses, which grow with a child using magnets, were not an option. Noah was too small, and Wallie would have had to wait months for one to be fabricated. His surgery could not be delayed that long.

Fortunately, there was an alternative: a unique surgery called rotationplasty. In this complex procedure, surgeons remove the tumor, along with the surrounding muscle and skin, while saving the blood vessels and nerves.

They then rotate the lower leg—the calf—and reattach it to the upper leg so the foot is facing backwards. That allows the child’s ankle joint to serve as a knee joint. Wearing a prosthesis for the lower leg, the child can not only walk, but also run, jump, and even play sports like soccer and basketball.

“The nice thing about rotationplasty is that it’s your own native tissue,” explains Dr. Christ. “It grows as the child grows. And it doesn’t wear out like an implant. It only gets better and stronger with time.”

‘No, we’re not going to do that’

The bad thing about a rotationplasty? It is a more visible amputation. And one foot points backwards.

“I remember breaking down,” says Noah’s mom, Ivy. “I was like, ‘No, we’re not going to do that. No. No way.’”

Wallie’s parents had a similar reaction. “I’m ashamed to say this, but it was a social acceptance thing,” his dad says. “We wanted him to be ‘normal’ and not be seen as disabled.”

But the prospect of never playing soccer again was tough for Wallie to swallow.

“So I get to keep my leg, but I can’t run?” he’d ask his parents.

“He would always look really sad,” says his mom.

As it turned out, Wallie’s tumor ended up being so large that rotationplasty was the only option. “When we told Wallie, he was so happy!” Jeanne remembers. “He gave a big thumbs up. We realized that was what he had wanted all along.”

Noah decided he wanted a rotationplasty as well—a one-and-done surgery that would give him the best chance to be active throughout his life.

“He made that decision,” Darryl says. “And we supported him.”

The first surgery

Wallie had his surgery first. With his tumor taking up almost his entire leg, it promised to be the most complicated. And it was.

To prepare, Dr. Christ had worked closely with Vernon Tolo, MD, Chair Emeritus of Orthopedic Surgery at CHLA, who has performed 11 rotationplasties over a 50-plus-year career. Dr. Tolo also observed the surgery.

But as Dr. Christ carefully began removing the affected bone, there was a problem: The tumor had invaded Wallie’s femoral vein, a highly unusual occurrence. Part of the vein would now have to be removed—and then reconnected. That required a specialized vascular reconstruction.

Fortunately, the team had a contingency plan, calling in Erin Meisel, MD, an orthopedic surgeon at CHLA who specializes in hand and microvascular surgery. Dr. Meisel expertly reconstructed the vein.

“Without Dr. Meisel, we would have had to amputate Wallie’s entire leg,” Dr. Christ says. “That’s the importance of being at a center like CHLA, where we have all these pediatric subspecialists working together. It’s essential for making a surgery like this successful.”

A special visitor

Shortly after Wallie’s surgery, Noah and his parents came to see him in the hospital. Noah’s own surgery was just two weeks away.

His parents didn’t know if seeing Wallie’s leg would give their son second thoughts. But it was just the opposite.

“Noah was very casual about the whole thing,” his dad says. “He wasn’t even like, ‘Whoaaa!’ He was just like, ‘Oh, OK.’ For him, he thought it looked normal.”

How important was it that each had a friend going through the same thing? That’s immeasurable, says Noah’s oncologist, Jessica Sheth Bhutada, MD.

“Rotationplasty is such a unique surgery,” says Dr. Sheth Bhutada. “To have someone else your own age going through the same thing at the same time feels like an incredible stroke of luck.”

On Dec. 23, 2022, Noah underwent his rotationplasty. His surgery was also successful, and both boys recovered well.

But before either could get fitted for a prosthesis—and start the long process of learning to walk again—they faced six more months of chemo. Luckily, they had each other.

‘Party in the room’

The boys’ appointments and chemotherapy schedules didn’t always match up. But when they did, it was cause for celebration.

Sometimes, the boys would call each other and excitedly realize they were both getting a blood transfusion at CHLA. And thanks to the floor nurses, they were even roommates during some hospital stays—turning a five-day stint of getting chemotherapy into more of an extended sleepover.

During those stays, Wallie and Noah played Roblox, foosball, and a million other games. Everyone played cards and watched sports on TV. They stayed up late chatting and laughing.

“It was like a party in the room,” Jeanne says.

The friendship has been just as important for the parents as for the kids. “It has helped so much to have them in our lives,” Ivy says. “I think it was God’s way of telling us that we are not alone.”

Reaching new milestones

It’s now been nearly two years since Wallie and Noah had their rotationplasties.

They both can walk without their crutches. Running will take more time. But recently, Noah, now 11, reached a new milestone: He jumped.

“I was really emotional,” Darryl shares, wiping away his tears.

And Noah? “He’s a very nonchalant guy!” his dad says with a smile. “But I could tell that deep inside, he was happy.”

Although they each have gone through cancer relapses and additional treatment, both Wallie and Noah are currently doing well. The families are extremely grateful to CHLA—for their doctors, their many nurses, physician assistants, prosthetists, Child Life specialists, physical therapists, dog therapy volunteers, and more.

“We could not have been in a better place than Children’s Hospital Los Angeles,” Darryl says.

Because they live an hour apart—Wallie in Hawthorne, Noah in Glendale—the boys don’t see each other as much anymore. But their friendship lives on. They play games online for hours sometimes. Or they’ll call or video chat.

“Wallie and Noah, now that’s a real friendship,” Clement says, shaking his head and smiling.

Noah’s family agrees.

“This cancer experience has been so difficult,” Darryl says. “But getting to meet these wonderful people is something I’m extremely grateful for. It will leave a mark on my heart forever and ever.”