When reconstructing bone defects, it is always important to ensure sufficient muscular coverage.,,,– This coverage lowers the infection risk and is crucial for the success of the reconstruction procedure. Advances in microvascular free flaps, as in local rotational flaps, have extended the indications of limb-sparing surgery and reduced local wound healing problems. Finally, careful hemostasis and drainage should be carried out to avoid poor wound healing., Bednar assessed the efficacy of tranexamic acid in decreasing operative blood loss and the need for intraoperative transfusion in metastatic spine surgery but could not shown any benefit of this prophylaxis. It has been observed that limb-saving surgery result in a better functional outcome compared with conditions after amputation. Pring described a good functional result of 77% according to the Musculosceletal Tumor Society Score (MSTS) after chondrosarcoma resection and limb-saving surgery. Karaharju emphasized the psychological advantage for the patient after internal hemipelvectomy. Furthermore, phantom pain and extensive intraoperative blood loss are typical complications of amputations., The postoperative course after external hemipelvectomy may be complicated by wound healing disorders, bladder, sexual and bowel dysfunction.
Traditionally, the solid-ankle cushion-heel (SACH) foot has been recommended for the Canadian hip disarticulation design due to its moderate weight, low cost, and excellent durability. So long as the heel durometer is very soft, knee stability with this foot has generally been quite acceptable.
Hemipelvectomy and hip disarticulation
Dynamic-response feet, which provide a subjective sense of active push-off, can also be used to advantage for the hip-level amputee. The Carbon Copy II, Seattle foot, Springlite, and Flex-Foot have all been successfully utilized for this type of patient. They seem to provide a more rapid cadence, as noted by one long-term hip disarticulation wearer, who stated after receiving a Seattle foot, "For the first time in my life I can pass someone in a crowd."
What is a Hemipelvectomy? (with pictures) - wiseGEEK
Prosthetic fitting is typically limited to motivated and physiologically vigorous individuals; still, a significant number do not become long-term wearers. To investigate this further, the senior author (T.v.d.W) studied a group of 20 male and female hip disarticulation and transpelvic amputees who were representative of the age and diagnoses typically encountered. Only 15% had been full-time users of their initial prostheses; many complained of how cumbersome or uncomfortable their rigid sockets seemed.
INTERNAL HEMIPELVECTOMY: REPORT ONEIGHT …
Another hip joint option is the Otto Bock four-bar knee disarticulation joint mounted in reverse as proposed by Peter Tuil of The Netherlands (Fig 21B-6.). Benefits claimed are parallel to those expected from a polycentric knee unit: increased ground clearance during swing phase due to the inherent "shortening" of the linkage in flexion and enhanced stability at heel strike amputees comment favorably on the smooth deceleration and good appearance while sitting that this joint offers.
hemipelvectomy photos on Flickr | Flickr
Other than the exception discussed above, knee mechanisms are selected by the same criteria as for transfemoral (above-knee) amputees. The single-axis (constant-friction) knee remains the most widely utilized due to its light weight, low cost, and excellent durability. Friction resistance is often eliminated to ensure that the knee reaches full extension as quickly as possible. A strong knee extension bias enhances this goal and offers the patient the most stable biomechanics possible with this mechanism. Although the single-axis type was proposed as the knee of choice for the Canadian hip disarticulation design, more sophisticated mechanisms have proved their value and are gradually becoming more common.
Hip Disarticulation, Prosthetics – Hanger Clinic
Introduction: Bone is the third most common site of metastatic disease. Treatment of metastatic tumours of proximal femur usually used to be either palliative in the form of radiotherapy and chemotherapy or a very radical in form of hemipelvectomy and hip disarticulation. Both forms of treatment were associated with dismal outcomes. Now with the technological advancement and refinement in surgeries a custom made hip prosthesis offers a much better treatment option to the surgeon and a good quality life to the patient.