Bone Health

Lower-extremity amputation is one of the oldest known surgically performed procedures. The original surgical principles as described by Hippocrates remain true today. Refinements of surgical technique such as hemostasis, anesthesia, and improved perioperative conditions have occurred, but only relatively small technical improvements have been made. Amputation is still often viewed as a failure of treatment. The responsibility for performing an amputation may even fall on the most junior member of the surgical team. Whatever the reason for performing an extremity amputation, it should not be viewed as a failure of treatment. Amputation can be the treatment of choice for severe trauma, vascular disease, and tumors. Patients and family members must be aware of their options and have realistic expectations of surgical outcomes in order to make informed decisions regarding amputation.
Synonyms and related keywords: hemipelvectomy, hip disarticulation, above-knee amputation, AKA, below-knee amputation, BKA, knee disarticulation, Symes amputation, hindfoot amputation, Boyd amputation, Chopart amputation, Lisfranc amputation, transmetatarsal amputation, toe disarticulation, toe amputation, peripheral vascular disease
Ertl, Ertl & Pritchett 2008

External Hemipelvectomy refers to amputation of the innominate bone (ilium, pubis, and ischium), also known as the hemipelvis or os coxae, including the ipsilateral extremity. Other terms synonymous with hemipelvectomy are interilioabdominal amputation, interpelvioabdominal amputation, interiliosacropubic amputation, transiliac amputation, interinnominoabdominal amputation, hindquarter resection or amputation, disarticulation of the innominate bone, and sacroiliac disarticulation. Gordon-Taylor described the procedure as “…one of the most colossal mutilations practiced on the human frame” (Pack 1964). The elective procedure is used for malignancies of the pelvis or proximal thigh when a more conservative procedure cannot achieve adequate margins. Traumatic hemipelvectomies are rare injuries seen in high-energy blunt trauma or accidents involving heavy machinery (Beal 1989). Both traumatic and oncologic hemipelvectomies will be discussed in this chapter, with emphasis on elective hemipelvectomy for oncologic indications. Brian Mullis, M.D. & Gary D. Bos. M.D. Brief Outline: External Hemipelvectomy I. Introduction II. Historical Perspective Elective Hemipelvectomy Traumatic Hemipelvectomy III. Anatomic and Physciologic Considerations Elective Hemipelvectomy Anatomy Traumatic Hemipelvectomy Anatomy Elective Hemipelvectomy Physiology Traumatic Hemipelvectomy Physiology IV. Natural History and Classifications Elective Hemipelvectomy Traumatic Hemipelvectomy V. Diagnosis and Recognition Elective Hemipelvectomy Traumatic Hemipelvectomy VI. Treatment Elective Hemipelvectomy Traumatic Hemipelvectomy VII. Summary Elective Hemipelvectomy Traumatic Hemipelvectomy X. References XI. Patient Education Summary