Hip Disarticulation and Hemipelvectomy: Practical Approaches From Juvenile to Adulthood

John Angelico, CP, OTR
David Rotter, CPO
James Kaiser, CP
Holly Schaffer
Scheck and Siress Prosthetics, Inc.
Oak Park, Illinois

Jeffery Ackman, MD
Shriner's Hospital, Chicago

Christine Sorquist, PT
PhysioTherapy Associates
Evanston, Illinois

This paper is a multidisciplinary team approach for the care of the patient with a hip disarticulation or hemipelvectomy amputation. The authors include the patient, the orthopedic surgeon, the licensed/certified prosthetist and the physical therapist.

The prescription rationale and the clinic team approach for the initial clinic evaluation and subsequent evaluations with the child and family are presented by our orthopedic surgeon in the cases of juvenile amputation. The primary diagnosis is determined. The team members present recommendations to formulate the prescription and the rehabilitation program all of which includes and is reviewed with the child and family.

Case presentations include patients seen over the past twenty-five years and range from pediatric to adolescent to adult. The cases include juvenile unilateral and bilateral hip disarticulation patients, an adolescent hemipelvectomy patient, an adult hemicorporectomy and a hemipelvectomy patient, and a hip disarticulation patient. The hip flexion assist systems is reviewed as well as component selection is reviewed.

Cast impressions and rectification of the positive model will demonstrate the use of ischial-ramus containment in the hip disarticulation socket design. Evaluation test socket fabrication using synthetic casting materials is presented. The fabrication of definitive sockets using flexible thermoplastic interface material in a framed thermoplastic socket is presented. Cosmetic finishing techniques are presented.

Static and dynamic alignment is reviewed in the office setting as well as in an every day living setting. Gait training and safety considerations are presented in the use of the prosthesis.

Our patient is presenting her real life practical concerns in using her prosthesis.