Rehabilitation after hemipelvectomy

Hip disarticulation and hemipelvectomy prostheses: A review of the literature

BACKGROUND

Although the global population of people with a hip disarticulation (HD) or hemipelvectomy (HP) amputation is small, the degree of disability is high, affecting function and independence. A comprehensive literature review is needed to examine the evidence for prostheses in these amputation levels.

METHOD

A scoping literature review was conducted to examine related research documents from 1950 to September 2020, found using Scopus, Web of Science, PubMed, and Google Scholar databases. Studies evaluated (retrospectively or prospectively) HD or HP prostheses and were written in English. Study design and protocol, research instrument, sample size, and outcome measures were reviewed.

RESULTS

In the past 70 years, 53 articles that evaluated HD or HP prostheses were published. Most research was conducted in the United States (24 articles) and Japan (nine articles). In 42 articles, authors prospectively evaluated the effects of prostheses in these amputation levels. On average, prospective studies had four (SD = 5) participants. Since 1950, only five prospective studies evaluated HD or HP prostheses with 10 or more participants. Moreover, sufficient information was often unavailable for research replication.

CONCLUSION

More evidence is needed regarding the effects of HD or HP prosthetic components (i.e. hip, knee, ankle, socket type, and suspension system) on gait, patient satisfaction, prosthetic use, interface pressure, and energy expenditure. Articles mostly have small sample sizes that reduce confidence in the reliability of their findings and limit generalizability. Future investigations are needed with vigorous methodology and larger sample sizes to provide strong statistical conclusions.

Functional outcome measures of patients following hemipelvectomy

BACKGROUND

Major amputations are indicated for curative treatment of some tumors of the pelvis. Previous literature suggests that patients with a hemipelvectomy amputation are more efficient walking with crutches than using a prosthesis.

OBJECTIVES

The purpose of this study was to evaluate whether modern prosthetic use after hemipelvectomy may be a viable option for patients than in the past.

STUDY DESIGN

Case control trial.

METHODS

We identified five patients who underwent hemipelvectomy amputation and fit with high-level prosthetic components. Patients were evaluated using a timed up and go, 5-m walk, 400-m walk, and stair climb tests to evaluate functional performance with a prosthesis and without. Short Form-36 scores were collected as well. These results were compared to matched controls.

RESULTS

There was a trend for faster locomotion using crutches over wearing a prosthesis in the timed up and go, and 5-m and 400-m walk; no difference was seen in stair climbing. Short Form-36 scores showed decreased physical component score, but equal mental component score compared to the general population.

CONCLUSION

Our results show that in addition to advances in surgical techniques, prosthetic rehabilitation and management are beginning to optimize functional mobility with the prosthesis.

CLINICAL RELEVANCE

Patients who use a modern prosthesis following hemipelvectomy demonstrated good clinical function with and without their prosthesis. Although health status scores were decreased in the physical component, mental component scores were equal to healthy controls.

Functional outcome of hip disarticulation and hemipelvectomy: a cross-sectional national descriptive study in the Netherlands

OBJECTIVE

To describe characteristics of hip disarticulation and hemipelvectomy amputees, to assess their level of activities, participation and experienced limitations in mobility and to describe the amputation-related problems.

DESIGN

A cross-sectional study.

SETTING

Patients were mainly recruited via orthopaedic workshops in the Netherlands.

SUBJECTS

Forty-six patients with an acquired unilateral hip disarticulation or hemipelvectomy at least one year post amputation.

MAIN OUTCOME MEASURES

Sickness Impact Profile 68 (SIP 68) to assess the level of activity and participation and the questionnaire Rising and Sitting Down, Walking and Climbing Stairs to assess perceived limitations in mobility.

RESULTS

The 46 patients (31 with hip disarticulation and 15 with hemipelvectomy) had a mean age of 55.8 years (SD 12.1). In 78% of cases the reason for amputation was a tumour. Mean SIP 68 was low, 10.5 (SD 6.9). Hip disarticulation amputees had significantly poorer emotional stability than the hemipelvectomy amputees (P = 0.04). All amputees experienced considerable limitations in their mobility according to the Rising and Sitting Down, Walking and Climbing Stairs scores.

CONCLUSIONS

Hip disarticulation and hemipelvectomy amputees have a relatively high level of activity and participation (SIP scores) but at the same time experience limitations in walking, rising and sitting down and climbing stairs.

Total hip disarticulation prosthesis with suction socket: report of two cases

A majority of hip disarticulations are performed in young people, with malignancy being the most common cause. The exoskeletal Canadian Hip Disarticulation prosthesis had been widely used as a standard total hip disarticulation prosthesis until recently when an endoskeletal modular version became the prosthesis of choice. However, the "basket-shaped" socket provided by the standard total hip disarticulation prostheses has been a source of discomfort and a reason for prosthetic rejection by many patients. This report concerns two patients with true lower limb disarticulation at the hip joint. Both of the patients failed to adapt to the standard total hip disarticulation prosthesis but successfully used a new total contact suction socket design. This new prosthesis provided improved suspension, better patient compliance, and enhanced prosthetic acceptance and mobility.

Hemipelvectomy. Postoperative rehabilitation assessed on the basis of 41 cases

Rehabilitation was evaluated on the basis of 41 consecutive hemipelvectomies for malignant tumours. Owing to early metastasization and death, 11 patients were not supplied with prostheses, while prosthetic fitting was attempted in the remaining 30. Of this number 27 completed prosthetic training, with the result that 15 used their prosthesis, while 12 discarded it after some time, six because of poor general health owing to recurrence of the tumours and six because they felt that the prosthesis was too heavy and difficult to wear. Twenty-three returned to work. After elimination of the most severely tumour-affected patients, there were 19 one-year survivors without recurrence. Thirteen of them were using their prosthesis every day, and thirteen had gone back to work. Serious mental sequelae were found in five patients, including four with long-lasting exogenous depressions and one with anxiety neurosis.