27295 Disarticulation of hip

Name of the Procedure:

Disarticulation of the Hip (also known as Hip Disarticulation or Transpelvic Amputation)

Summary

Disarticulation of the hip is a surgical procedure where the leg is entirely removed from the body at the hip joint. This typically involves removing the entire femur along with surrounding muscles and tissues.

Purpose

Disarticulation of the hip is performed to address severe medical issues such as malignant tumors, severe trauma, uncontrollable infections, or congenital anomalies. The primary goal is to remove the diseased or damaged tissue to save the patient's life or significantly improve their quality of life.

Indications

• Malignant tumors in the thigh or hip region that cannot be effectively treated with less extensive surgery.
• Severe trauma to the leg and hip area where reconstructive surgery is not possible.
• Chronic, severe infections that have not responded to other treatments.
• Congenital limb deformities that severely impair function and quality of life.

Preparation

• Patients are usually instructed to fast for at least 8 hours before the surgery.
• Blood tests, imaging studies (such as X-rays or MRIs), and a thorough medical evaluation are conducted to plan the procedure.
• Preoperative consultations with the surgical team, anesthesiologist, and possibly a pain management or physical rehabilitation specialist.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is completely unconscious and pain-free.
2. Incision: The surgeon makes incisions around the hip joint to access the femur and surrounding tissues.
3. Ligament and Muscle Separation: Muscles and ligaments are carefully separated from the femur.
4. Femur Removal: The femur is disarticulated from the hip joint.
5. Closure: Blood vessels and nerves are managed appropriately, and the incision site is closed with sutures or staples.
6. Dressings and Stabilization: The area is bandaged and stabilized to promote healing.

Tools Used

• Surgical scalpels and scissors
• Bone saws and drills
• Clamps and forceps

Duration

The procedure typically takes between 2 to 5 hours, depending on complexity.

Setting

Disarticulation of the hip is performed in a hospital operating room.

Personnel

• Orthopedic or surgical oncologist
• Surgical nurses
• Anesthesiologist
• Possibly a vascular or plastic surgeon for complex cases

Risks and Complications

• Infection
• Bleeding
• Blood clots (Deep Vein Thrombosis or Pulmonary Embolism)
• Phantom limb pain
• Delayed wound healing
• Need for further surgeries

Benefits

• Removal of life-threatening or severely diseased tissues
• Potentially improved quality of life
• Prevention of disease progression
• Pain relief from the affected area

Recovery

• Post-procedure monitoring in the hospital for several days.
• Pain management with medications.
• Physical rehabilitation starting soon after surgery.
• Wound care instructions and follow-up appointments for suture removal and progress checks.
• Recovery time varies; full physical adaptation to the procedure may take several months.

Alternatives

• Limb-sparing surgery (if possible)
• Radiation or chemotherapy for tumors
• Conservative treatment for infections (e.g., antibiotics, debridement)
• Prosthetics and orthotics for congenital deformities

Patient Experience

• Post-surgery, the patient will likely experience significant pain, managed with medications.
• Initial discomfort and a period of adaptation to the absence of the limb.
• Emotional and psychological support may be necessary due to the physical and lifestyle changes.
• Regular physical therapy to improve mobility and adapt to prosthetics if used.