Levels
| Level | Features |
|---|---|
| Hip disarticulation | Removal through the hip joint. Posterior gluteal flap |
| Internal hemipelvectomy | Resection of part of the pelvis with limb salvage |
| External hemipelvectomy | Removal of the limb with the hemipelvis. Posterior or anterior myocutaneous flap |
Technique
- Hip disarticulation ligates the femoral vessels and divides the femoral nerve under tension below the inguinal ligament
- Muscles are detached at their femoral insertions
- A posterior gluteal flap covers the acetabulum
- Hemipelvectomy divides the pelvis at the sacroiliac joint and symphysis after exposure of the iliac vessels
- Blood loss is high, so cross match and use cell salvage when tumour is not present
Indications
- Pelvic and proximal femoral sarcoma
- Uncontrollable infection, gas gangrene
- Severe trauma and ischaemia
- Failed limb salvage
- Ischaemia extending into the thigh
- Massive soft tissue sarcoma of the thigh
Outcomes
- High energy cost of walking. Many choose crutches over a prosthesis
- Canadian hip disarticulation prosthesis
- Phantom limb pain is common
- Flap necrosis and infection are the main early complications
- Sitting balance is affected after hemipelvectomy and a seat socket helps
- Few elderly vascular patients walk with a prosthesis at this level
- Rehabilitation focuses on transfers, wheelchair skills and crutch walking
- Wound complications occur in up to half after external hemipelvectomy
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.