Prosthetic rehabilitation after hip disarticulation and hemipelvectomy
Advances in prosthetic design, components, materials and fabrication techniques allow patients who have the ability to walk on uneven surfaces and at variable cadences to function at a higher level than traditionally thought. Design changes have made the socket more comfortable and allow patients to wear their prostheses throughout the day. The prosthetic components (hip-knee) optimize gait stability and efficiency and reduce the risk of falling. These advances also help patients with hip disarticulation or hemipelvectomy-level amputation stabilize their prostheses and improve their initiation of gait and pelvic rotation. All these factors contribute to a more efficient, natural gait.
Technology, custom fit and specialized care put amputees back in action
Hip disarticulation and hemipelvectomy amputation are relatively rare and invasive procedures. Transpelvic amputations are associated with extensive morbidity and mortality, both at the time of surgery and immediately thereafter.
Beyond survival, success for these patients is measured in quality of life, including level of mobility, and functional independence. In collaboration with the amputee rehabilitation team, Mayo Clinic physiatrists and physical therapists help these patients regain a remarkably high rate of independence in self-care and mobility.
"With the latest prosthetic technology, people with a full-leg amputation can walk again," says physiatrist Karen L. Andrews, M.D., with the Department of Physical Medicine and Rehabilitation at Mayo Clinic in Rochester, Minn. "But many physicians are not yet aware that the technology exists."
In the past few years, Dr. Andrews and her colleagues at Mayo have offered rehabilitation with the latest, custom-fitted prostheses that have state-of-the-art components, including hip and knee joints equipped with microprocessors. The computers located at the hinges tell each joint how much weight it needs to bear and where it is in space. "People used to have to think about each step when they were moving their prostheses," Dr. Andrews explains. "Now the microprocessors in the joints do the thinking about each stride."
Mayo Clinic treats between 10 and 20 patients a year who undergo hemipelvectomy because of tumors or traumatic injuries. The computerized prostheses are options for many of them.
For patients like Robert Anderson, an outdoorsy 40-year-old, this technology and the specialized physical therapy that Mayo Clinic provides can dramatically improve quality of life after hemipelvectomy. When he learned the tumor in his leg would require a hip-level amputation, Mr. Anderson's first reaction was that he'd rather die. Believing that walking would be impossible after the surgery, he was ready to forgo the treatment.
After consulting with staff at Mayo Clinic, he received news that changed his mind, and he decided to undergo the hemipelvectomy. With physical therapy, Mr. Anderson learned to walk over the course of several weeks using the new prosthesis. Today, he not only is walking but has returned to the outdoor activities he loves.
"With these new computerized components, we're seeing people walking more smoothly than I ever would have hoped," Dr. Andrews says. "It's important that doctors and patients know that for people requiring this level of amputation, there's technology available to provide a very active, very full life."
Prosthetic fitting process requires expertise
The prosthetic fitting process for patients undergoing hemipelvectomy and hip disarticulation requires considerable expertise as well as careful follow-up from both the patient and the rehabilitation team. After hemipelvectomy, patients frequently have more variability at the amputation site than patients undergoing other amputation procedures. The surgical technique used, as well as the amount of soft tissue involvement, varies among patients. The surgical team tries to shape bone surfaces to allow weight bearing and provide as much soft tissue coverage as possible. Diligent postoperative wound care also is important.
Recognizing these challenges, Mayo Clinic physiatrists and orthopedic surgeons are currently working on two studies attempting to identify specific variables strongly associated with successful prosthetic fit and functional outcomes. Mayo researchers hope that their study results will help clinicians offer appropriate presurgical counseling and make well-informed choices about prosthetic fit.
Points to remember
- Each year at Mayo Clinic between 10 and 20 patients undergo hemipelvectomy because of tumors or traumatic injuries.
- New custom-fitted prostheses that have state-of-the-art components, including hip and knee joints equipped with microprocessors, allow people with a full-leg amputation to walk again.