Hemipelvectomy, also known as a pelvic resection, is a surgical procedure that involves the removal of portion of the

pelvic girdle The pelvis (plural pelves or pelvises) is the lower part of the trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis, or pelvic skeleton). The p ...

. This procedure is most commonly performed to treat oncologic conditions of the pelvis. Hemipelvectomy can be further classified as ''internal'' and ''external'' hemipelvectomy. An ''internal'' hemipelvectomy is a limb-sparing procedure where the

innominate bone The hip bone (os coxae, innominate bone, pelvic bone or coxal bone) is a large flat bone, constricted in the center and expanded above and below. In some vertebrates (including humans before puberty) it is composed of three parts: the ilium, ischi ...

is resected while preserving the

ipsilateral Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...

limb. An ''external'' hemipelvectomy involves the resection of the innominate bone plus

amputation Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on indi ...

of the ipsilateral limb.

Medical uses

Hemipelvectomy is generally reserved for the treatment of pelvic

neoplasm A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

s. Examples of malignancies that are treated with hemipelvectomy include

osteosarcoma An osteosarcoma (OS) or osteogenic sarcoma (OGS) (or simply bone cancer) is a cancerous tumor in a bone. Specifically, it is an aggressive malignant neoplasm that arises from primitive transformed cells of mesenchymal origin (and thus a sarcoma) a ...

chondrosarcoma Chondrosarcoma is a bone sarcoma, a primary cancer composed of cells derived from transformed cells that produce cartilage. A chondrosarcoma is a member of a category of tumors of bone and soft tissue known as sarcomas. About 30% of bone sarcomas ...

, and

Ewing's sarcoma Ewing sarcoma is a type of cancer that forms in bone or soft tissue. Symptoms may include swelling and pain at the site of the tumor, fever, and a bone fracture. The most common areas where it begins are the legs, pelvis, and chest wall. In about ...

. Rarely, hemipelvectomy is performed in settings of

traumatic injury An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, or o ...

and

osteomyelitis Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus, while the ...

. Indications for ''external'' hemipelvectomy include neoplastic extension into the

sciatic nerve The sciatic nerve, also called the ischiadic nerve, is a large nerve in humans and other vertebrate animals which is the largest branch of the sacral plexus and runs alongside the hip joint and down the lower limb. It is the longest and widest si ...

, where loss of function of the lower extremity is anticipated. ''Internal'' hemipelvectomy is preferred when complete resection of the tumor is possible without sacrificing the lower extremity. If ''external'' hemipelvectomy cannot provide a greater degree of tumor resection compared to ''internal'' hemipelvectomy, ''internal'' hemipelvectomy is recommended. ''Internal'' hemipelvectomy must only be considered when the surgical approach can ensure the preservation of critical neurovascular structures in the region.

Complications

As with any surgical procedure, risks include infection, blood loss, damage to surrounding structures, cardiac/pulmonary complications, and adverse reactions to anesthesia. Risks of ''external'' hemipelvectomy include: * Disfigurement * Loss of ambulation *

Phantom limb A phantom limb is the sensation that an amputated or missing limb is still attached. Approximately 80 to 100% of individuals with an amputation experience sensations in their amputated limb. However, only a small percentage will experience painf ...

pain * Bladder dysfunction * Sexual dysfunction * Bowel dysfunction Risks of ''internal'' hemipelvectomy include: * Leg-length discrepancy * 'Flail hip' or 'floating hip' (referring to hypermobility of the hip joint) * Hip instability

Technique

Prior to performing a hemipelvectomy, surgeons must possess detailed knowledge of the pelvic anatomy and its relation to the pelvic tumor. Imaging studies such as

conventional radiography Projectional radiography, also known as conventional radiography, is a form of radiography and medical imaging that produces two-dimensional images by x-ray radiation. The image acquisition is generally performed by radiographers, and the images ...

computed tomography A computed tomography scan (CT scan; formerly called computed axial tomography scan or CAT scan) is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers ...

, and

magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio wave ...

help the surgeon visualize the anatomy and its relationship to the local pathology.

Surgical oncology Surgical oncology is the branch of surgery applied to oncology; it focuses on the surgical management of tumors, especially cancerous tumors. As one of several modalities in the management of cancer, the specialty of surgical oncology has evolved ...

techniques are utilized when resecting tumors of the pelvis. Such techniques ensure that adequate

resection margin A resection margin or surgical margin is the margin of apparently non-tumorous tissue around a tumor that has been surgically removed, called " resected", in surgical oncology. The resection is an attempt to remove a cancer tumor so that no portio ...

s are obtained at the time of surgery to minimize tumor recurrence. The Enneking and Dunham classification system was developed in 1978 to aid surgeons in characterizing pelvic resections. This classification scheme breaks down pelvic resections into 3 subtypes: Type I, Type II, and Type III. Type I resections involve removal of the ilium. Type II resections involve removal of the peri-acetabular region. Type III resections involve removal of the ischial and/or

pubic In vertebrates, the pubic region ( la, pubis) is the most forward-facing (ventral and anterior) of the three main regions making up the coxal bone. The left and right pubic regions are each made up of three sections, a superior ramus, inferior ra ...

region. Resection of pelvic bone typically requires subsequent reconstruction to ensure stability of the hip joint, particularly in ''internal'' hemipelvectomy. Examples of pelvic reconstruction include the use of an

allograft Allotransplant (''allo-'' meaning "other" in Greek) is the transplantation of cells, tissues, or organs to a recipient from a genetically non-identical donor of the same species. The transplant is called an allograft, allogeneic transplant, o ...

autograft Autotransplantation is the transplantation of organs, tissues, or even particular proteins from one part of the body to another in the same person ('' auto-'' meaning "self" in Greek). The autologous tissue (also called autogenous, autogene ...

, or

prosthesis In medicine, a prosthesis (plural: prostheses; from grc, πρόσθεσις, prósthesis, addition, application, attachment), or a prosthetic implant, is an artificial device that replaces a missing body part, which may be lost through trau ...

to bridge the remaining ends of pelvic bone following resection.

Arthrodesis Arthrodesis, also known as artificial ankylosis or syndesis, is the artificial induction of joint ossification between two bones by surgery. This is done to relieve intractable pain in a joint which cannot be managed by pain medication, splin ...

is a technique that can be used in ''internal'' hemipelvectomy to fix the proximal

femur The femur (; ), or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with ...

to a segment of pelvic bone for the purposes of stabilizing the lower extremity.

Additional images

References

External links

Amputee Coalition of America

Pelvic Amputation: What is a Hemipelvectomy?
{{Muscle/soft tissue procedures Surgical oncology Surgical removal procedures Types of amputations