Hemipelvectomy in paraplegic patients with chronic osteomyelitis
Authors:
J. Wirth 1
; J. Fichtl 1
; P. Korpa 2
; A. Skalický 3,4
; J. Baxa 5
; J. Moláček 1
Authors‘ workplace:
Chirurgická klinika LF UK a FN Plzeň
1; Klinika ortopedie a traumatologie pohybového ústrojí LF UK a FN Plzeň
2; Oddělení plastické chirurgie, FN Plzeň
3; Lékařská fakulta UK v Plzni
4; Klinika zobrazovacích metod LF UK a FN Plzeň
5
Published in:
Rozhl. Chir., 2026, roč. 105, č. 8, s. 409-415.
Category:
Case Report
doi:
https://doi.org/10.48095/ccrvch2026409
Overview
Introduction: Hemipelvectomy – surgical removal of half of the pelvis including the ipsilateral limb, is a rare operation with a narrow indication spectrum, most often performed for malignant tumors in the proximal femur area with cranial spread. Other, less frequent indications include devastating trauma to the pelvic area and deep soft tissue infections involving the pelvic bones. In our two case reports, we present deep decubitus ulcers complicated by osteomyelitis of the pelvic bones in paraplegic patients.
Case report 1: We describe the case of a 33-year-old paraplegic who underwent right hemipelvectomy for osteomyelitis of the femur and pelvis. The procedure and postoperative period were without serious complications. Despite intensive postoperative rehabilitation, the patient later developed contralateral pressure ulcers and pelvic osteomyelitis on the opposite side, leading to the indication for a similar contralateral procedure. The patient is now 18 months after the second surgery, fully healed, doing well, and has a significantly higher quality of life compared to the preoperative period.
Case report 2: The second case depicts a 62-year-old paraplegic who was admitted for a right-sided hemipelvectomy due to extensive pressure ulcers and unilateral pelvis osteomyelitis. The procedure itself was uncomplicated; however, the postoperative course was complicated by cardiac failture (Tako-tsubo cardiomyopathy), which was successfully managed. The patient is now 2 years post-surgery with a very good quality of life.
Conclusion: The aim of these case reports is to present this radical and complicated operation as a curative method for pelvic osteomyelitis in a carefully selected group of patients.
Keywords:
Paraplegia – flap surgery – external hemipelvectomy – pelvic osteomyelitis – decubitus ulcers
Sources
1. Wedemeyer C, Kauther MD. Hemipelvectomy – only a salvage therapy? Orthop Rev (Pavia) 2011; 3 (1): e4. doi: 10.4081/or.2011.e4.
2. Kołodziejski L, Duber J, Pomykacz P et al. External hemipelvectomy. A last resort operation. Nowotwory 2023; 73 (2): 81–84. doi: 10.5603/njo.a2023.0014.
3. Sugarbaker PH, Chretien PA. Hemipelvectomy for buttock tumors utilizing an anterior myocutaneous flap of quadriceps femoris muscle. Ann Surg 1983; 197 (1): 106–115.
4. Senchenkov A, Moran SL, Petty PM et al. Soft-tissue reconstruction of external hemipelvectomy defects. Plast Reconstr Surg 2009; 124 (1): 144–155. doi: 10.1097/PRS.0b013e3181a80557.
5. Chan JW, Virgo KS, Johnson FE. Hemipelvectomy for severe decubitus ulcers in patients with previous spinal cord injury. Am J Surg 2003; 185 (1): 69–73. doi: 10.1016/s0002-9610 (02) 01123-6.
6. Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg Am 1978; 60 (6): 731–746.
7. Dudareva M, Ferguson J, Riley N et al. Osteomyelitis of the pelvic bones: a multidisciplinary approach to treatment. J Bone Jt Infect 2017; 2 (4): 184–193. doi: 10.7150/jbji.21692.
8. Gélis A, Dupeyron A, Legros P et al. Pressure ulcer risk factors in persons with spinal cord injury part 2: the chronic stage. Spinal Cord 2009; 47 (9): 651–661. doi: 10.1038/sc.2009.32.
9. Lima AL, Oliveira PR, Carvalho VC et al. Recommendations for the treatment of osteomyelitis. Braz J Infect Dis 2014; 18 (5): 526–534. doi: 10.1016/j.bjid.2013.12.005.
10. Brunel AS, Lamy B, Cyteval C et al. Diagnosing pelvic osteomyelitis beneath pressure ulcers in spinal cord injured patients: a prospective study. Clin Microbiol Infect 2016; 22 (3): 267.e1–267.e8. doi: 10.1016/j.cmi.2015.11.005.
11. Lack W, McKinley T. Marjolin’s ulcer: incidental diagnosis of squamous cell carcinoma on hemipelvectomy for recalcitrant pelvic osteomyelitis. Iowa Orthop J 2010; 30 : 174–176.
12. Richtr P, Hoch J, Svobodová K et al. Hemicorporectomy – the ultimate solution of terminal pelvic sepsis. Acta Chir Belg 2021; 121 (6): 432–436. doi: 10.1080/00015458.2020.1722930.
13. Ziran BH, Smith WR, Rao N. Hemipelvic amputations for recalcitrant pelvic osteomyelitis. Injury 2008; 39 (4): 411–418. doi: 10.1016/j.injury.2007.12.002.
14. Karaca MO, Özbek EA, Özyıldıran M et al. External and internal hemipelvectomy: a retrospective analysis of 68 cases. Jt Dis Relat Surg 2022; 33 (1): 132–141. doi: 10.52312/jdrs.2022.560.
15. Gavrankapetanovic I, Gavrankapetanovic F, Becirbegovic S et al. Hemipelvektomie, konstantní chirurgické dilema. Rozhl Chir 2007; 86 (12): 661–665.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2026 Issue 8
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Safety and Tolerance of Metamizole in Postoperative Analgesia in Children
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
- Obstacle Called Vasospasm: Which Solution Is Most Effective in Microsurgery and How to Pharmacologically Assist It?
Most read in this issue
- Současné výzvy dětské chirurgie: období mezi demografií, centralizací, regulací a rodiči
- Mondor’s disease as the initial presentation of breast cancer
- VIII. děčínské chirurgické dny
- 10. plzeňské dny HPB a mamární chirurgie