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Related Experiment Videos

Hemipelvic amputations for recalcitrant pelvic osteomyelitis.

Bruce H Ziran1, Wade R Smith, Nalini Rao

  • 1Department of Orthopaedic Trauma, St. Elizabeth Health Center, Northeast Ohio Universities College of Medicine, Youngstown, OH 44501, United States. Bruce_Ziran@hmis.org

Injury
|March 7, 2008
PubMed
Summary

Hemipelvectomy is a life-saving procedure for severe pelvic infections unresponsive to other treatments. While associated with mortality, it offers a palliative solution for selected patients, particularly those with sepsis or severe tissue damage.

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Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Trauma Surgery

Background:

  • Recalcitrant deep pelvic infections pose significant challenges, often leading to life-threatening sepsis or an intolerable existence.
  • Conservative treatments like debridement and local wound care frequently fail in these complex cases.

Purpose of the Study:

  • To evaluate the outcomes of hemipelvectomy in patients with deep pelvic infections that were refractory to other treatments.
  • To identify factors associated with survival and recurrence of infection post-hemipelvectomy.

Main Methods:

  • A retrospective cohort study was conducted at a tertiary referral center.
  • Twenty patients with pelvic girdle infections underwent hemipelvectomy (internal, external, or hemicorporectomy) due to sepsis, putrid tissue, or both.

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  • Treatments included multidrug antibiotics and long-term suppression; outcomes assessed were survival and infection recurrence.

    • Main Results:

    • Six of 20 patients died within six months, primarily those with multiple comorbidities (Cierny-Mader class C).
    • Fourteen surviving patients had a mean follow-up of 28 weeks, with 10 infection-free and four requiring suppressive antibiotics.
    • Common infection etiologies included vasculopathy and spinal cord injury; pathogens were polymicrobial, with MRSA being most frequent. Mean blood loss was 3100 cc.

    Conclusions:

    • Hemipelvectomy is an effective palliative intervention for selected patients with severe pelvic infections presenting with sepsis or an intolerable state.
    • Despite potential complications, this radical surgery can improve quality of life when conservative measures fail.
    • Advanced age and vascular disease appear to be associated with poorer outcomes in this patient population.