Abstract
Amputations through the hip joint or pelvis are most often
indicated for radical treatment of neoplasia when a primary malignant soft tissue or osseous tumor of the extremity
involves several compartments, the sciatic nerve, or the femoral neurovascular structures. The goal of these procedures
when performed for neoplastic indications is to provide local
disease control. If a primary malignant bone tumor involves
the hip joint or a large portion of the ilium, a hemi-pelvectomy may be indicated. If the tumor involves only a limited
portion of the pelvis but no neurovascular structures, an
internal hemi-pelvectomy may be possible to preserve the
extremity. Amputations through the hip joint or pelvis result
in very similar functional results.
Less often, such amputations may be required in the
setting of vascular catastrophe, such as prosthetic graft
infection or nonhealing of above-knee amputation. Other
indications may include severe trauma with extensive
bone or soft tissue loss and neurovascular injury, or aggressive infectious diseases such as necrotizing fasciitis or
gas gangrene.
Surgical planning for hip disarticulation or hemi-pelvectomy should be based on imaging studies which clearly define the vascular status of the extremity, the anatomic margins of a tumor, or the extent of tissue loss or necrosis from
trauma or an infection. CT scan will provide the best images
to define osseous structures. MRI is most useful for defining
soft tissue extension of a tumor, relationship of a tumor to
neurovascular structures, and extent of marrow involvement.
MRI is also helpful in defining the limits of cellulitis or muscle
necrosis that may occur with aggressive infections. Appropriate vascular studies such a doppler ultrasound, digital subtraction angiography, or venography may be useful when
evaluating the patient with vascular disease.