Hemipelvectomy

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. Hemipelvectomy can be further classified as internal and external hemipelvectomy. An internal hemipelvectomy is a limb-sparing procedure where the innominate bone is resected while preserving the ipsilateral limb. An external hemipelvectomy involves the resection of the innominate bone plus amputation of the ipsilateral limb. Hemipelvectomy is generally reserved for the treatment of pelvic neoplasms. Examples of malignancies that are treated with hemipelvectomy include osteosarcoma, chondrosarcoma, and Ewing's sarcoma. Rarely, hemipelvectomy is performed in settings of traumatic injury and osteomyelitis. Indications for external hemipelvectomy include neoplastic extension into the sciatic nerve, 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. 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: Disfigurement Loss of ambulation Phantom limb pain Bladder dysfunction Sexual dysfunction Bowel dysfunction Complications of internal hemipelvectomy include: Leg-length discrepancy 'Flail hip' or 'floating hip' (referring to hypermobility of the hip joint) Hip instability Prior to performing a hemipelvectomy, surgeons must possess detailed knowledge of the pelvic anatomy and its relation to the pelvic tumor.