Surgical and Prosthetic-Orthotic Treatment of Patients with Unilateral Congenital or Early Childhood Hip Disarticulation or Hemipelvectomy
I. KRAJBICH, MD, FRCS(C), A. DE BARI, MD,S. HUBBARD, DIP P and OT, B SC, E. HAMILTON, OT,B. GIAVEDONI, CP(C), AND R OSBORNE, CP(C)
Four patients with the unusual problem of congenital or early childhood acquired unilateral high lower-limb amputation (hip disarticulation or hemipelvectomy) are presented. They developed the secondary deformities of lumbar scoliosis and pelvic obliquity. The deformities, in turn, could lead to abnormal development of the remaining hip joint, causing dysplasia, hip subluxation, and probably eventual dislocation, unless treatment is initiated. Treatment recommendations are discussed.
Prosthetic-orthotic management, combining a spinal orthosis with a leg disarticulation or hemipelvectomy prosthesis, was used. At least half of the patients, however, required surgical reconstruction using pelvic or femoral osteotomy of the remaining hip, or both. The need for spinal surgery has not been established clearly and remains to be determined with further experience.
Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8