Hemipelvectomy | |
---|---|
Other names | Hindquarter amputation, pelvic resection |
Specialty | Orthopedic surgery |
Hemipelvectomy, also known as a pelvic resection, is a surgical procedure that involves the removal of part of the pelvic girdle. This procedure is most commonly performed to treat oncologic conditions of the pelvis. [1] [2] Hemipelvectomy can be further classified as internal and external hemipelvectomy. [1] [2] An internal hemipelvectomy is a limb-sparing procedure where the innominate bone is resected while preserving the ipsilateral limb. [1] [2] An external hemipelvectomy involves the resection of the innominate bone plus amputation of the ipsilateral limb. [1] [2]
Hemipelvectomy is generally reserved for the treatment of pelvic neoplasms. [1] [2] Examples of malignancies that are treated with hemipelvectomy include osteosarcoma, chondrosarcoma, and Ewing's sarcoma. [1] Rarely, hemipelvectomy is performed in settings of traumatic injury and osteomyelitis. [1] Indications for external hemipelvectomy include neoplastic extension into the sciatic nerve, where loss of function of the lower extremity is anticipated. [1] Internal hemipelvectomy is preferred when complete resection of the tumor is possible without sacrificing the lower extremity. [1] If external hemipelvectomy cannot provide a greater degree of tumor resection compared to internal hemipelvectomy, internal hemipelvectomy is recommended. [1] Internal hemipelvectomy must only be considered when the surgical approach can ensure the preservation of critical neurovascular structures in the region. [1]
As with any surgical procedure, risks include infection, blood loss, damage to surrounding structures, cardiac/pulmonary complications, and adverse reactions to anesthesia.
Complications of external hemipelvectomy include: [1] [2]
Complications of internal hemipelvectomy include: [1] [2]
Prior to performing a hemipelvectomy, surgeons must possess detailed knowledge of the pelvic anatomy and its relation to the pelvic tumor. [1] Imaging studies such as conventional radiography, computed tomography, and magnetic resonance imaging help the surgeon visualize the anatomy and its relationship to the local pathology. [1] Surgical oncology techniques are utilized when resecting tumors of the pelvis. [1] Such techniques ensure that adequate resection margins are obtained at the time of surgery to minimize tumor recurrence. [1]
The Enneking and Dunham classification system was developed in 1978 to aid surgeons in characterizing pelvic resections. [1] [3] [4] This classification scheme breaks down pelvic resections into 3 subtypes: Type I, Type II, and Type III. [1] [3] [4] Type I resections involve removal of the ilium. [1] [3] [4] Type II resections involve removal of the peri-acetabular region. [1] [3] [4] Type III resections involve removal of the ischial and/or pubic region. [1] [3]
Resection of pelvic bone typically requires subsequent reconstruction to ensure stability of the hip joint, particularly in internal hemipelvectomy. [1] Examples of pelvic reconstruction include the use of an allograft, autograft, or prosthesis to bridge the remaining ends of pelvic bone following resection. [1] [4] Arthrodesis is a technique that can be used in internal hemipelvectomy to fix the proximal femur to a segment of pelvic bone for the purposes of stabilizing the lower extremity. [1] [4]
Hemipelvectomy | |
---|---|
Other names | Hindquarter amputation, pelvic resection |
Specialty | Orthopedic surgery |
Hemipelvectomy, also known as a pelvic resection, is a surgical procedure that involves the removal of part of the pelvic girdle. This procedure is most commonly performed to treat oncologic conditions of the pelvis. [1] [2] Hemipelvectomy can be further classified as internal and external hemipelvectomy. [1] [2] An internal hemipelvectomy is a limb-sparing procedure where the innominate bone is resected while preserving the ipsilateral limb. [1] [2] An external hemipelvectomy involves the resection of the innominate bone plus amputation of the ipsilateral limb. [1] [2]
Hemipelvectomy is generally reserved for the treatment of pelvic neoplasms. [1] [2] Examples of malignancies that are treated with hemipelvectomy include osteosarcoma, chondrosarcoma, and Ewing's sarcoma. [1] Rarely, hemipelvectomy is performed in settings of traumatic injury and osteomyelitis. [1] Indications for external hemipelvectomy include neoplastic extension into the sciatic nerve, where loss of function of the lower extremity is anticipated. [1] Internal hemipelvectomy is preferred when complete resection of the tumor is possible without sacrificing the lower extremity. [1] If external hemipelvectomy cannot provide a greater degree of tumor resection compared to internal hemipelvectomy, internal hemipelvectomy is recommended. [1] Internal hemipelvectomy must only be considered when the surgical approach can ensure the preservation of critical neurovascular structures in the region. [1]
As with any surgical procedure, risks include infection, blood loss, damage to surrounding structures, cardiac/pulmonary complications, and adverse reactions to anesthesia.
Complications of external hemipelvectomy include: [1] [2]
Complications of internal hemipelvectomy include: [1] [2]
Prior to performing a hemipelvectomy, surgeons must possess detailed knowledge of the pelvic anatomy and its relation to the pelvic tumor. [1] Imaging studies such as conventional radiography, computed tomography, and magnetic resonance imaging help the surgeon visualize the anatomy and its relationship to the local pathology. [1] Surgical oncology techniques are utilized when resecting tumors of the pelvis. [1] Such techniques ensure that adequate resection margins are obtained at the time of surgery to minimize tumor recurrence. [1]
The Enneking and Dunham classification system was developed in 1978 to aid surgeons in characterizing pelvic resections. [1] [3] [4] This classification scheme breaks down pelvic resections into 3 subtypes: Type I, Type II, and Type III. [1] [3] [4] Type I resections involve removal of the ilium. [1] [3] [4] Type II resections involve removal of the peri-acetabular region. [1] [3] [4] Type III resections involve removal of the ischial and/or pubic region. [1] [3]
Resection of pelvic bone typically requires subsequent reconstruction to ensure stability of the hip joint, particularly in internal hemipelvectomy. [1] Examples of pelvic reconstruction include the use of an allograft, autograft, or prosthesis to bridge the remaining ends of pelvic bone following resection. [1] [4] Arthrodesis is a technique that can be used in internal hemipelvectomy to fix the proximal femur to a segment of pelvic bone for the purposes of stabilizing the lower extremity. [1] [4]