Hemipelvectomy in paraplegic patients with chronic osteomyelitis

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.

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.