Internal Hemipelvectomy (Pelvic Tumour Resection)

⚙️What This Procedure Involves

The approach and extent depend on the tumour location within the pelvis (classified by Enneking/Dunham zones). The affected portion of the pelvis is resected with a margin of healthy tissue. Reconstruction options include no reconstruction (flail hip — accepted for iliac wing resections), custom pelvic prosthesis, saddle prosthesis, allograft reconstruction, or hip transposition (if the acetabulum is preserved). The operation takes four to eight hours and often involves orthopaedic, vascular, urological, and plastic surgical teams.

💡Why It May Be Recommended

Internal hemipelvectomy is the limb-preserving alternative to hindquarter amputation for pelvic tumours. It preserves the limb while achieving adequate tumour margins.

⚖️Non-Operative Alternatives

Hindquarter amputation (if limb salvage is not feasible), radiotherapy (for radiosensitive tumours), chemotherapy, and observation for slow-growing tumours in elderly patients.

📋Preparing for Surgery

Specialist sarcoma centre. Full staging. CT and MRI with 3D reconstruction for surgical planning. CT angiography for vascular anatomy. MDT discussion. Pre-operative embolisation may be needed. Psychological preparation.

✅Expected Benefits

Limb preservation with tumour removal. Functional outcomes vary depending on the extent of resection and reconstruction — some patients walk independently, others require aids.

⚠️Common Risks

• Major surgeryExpected

  This is one of the most complex operations in orthopaedic surgery.

• Significant blood lossExpected

  Transfusion always needed. Cell salvage not used in oncology.

• Prolonged recoveryExpected

  Hospital stay one to three weeks. Full recovery twelve to eighteen months.

• Functional limitationExpected

  Depending on the resection, hip abductor weakness, limb shortening, and gait alteration are common.

🔴Less Common but Serious Risks

• Wound complicationsCommon

  Very common due to the extensive surgery. Risk approximately 20–30%.

• InfectionCommon

  Deep infection. Risk approximately 10–15%.

• Sciatic or femoral nerve injuryUncommon

  May be unavoidable depending on tumour location.

• Vascular injuryUncommon

  Iliac vessels at risk.

• Implant/reconstruction failureLong-term

  Custom prostheses may loosen or dislocate. Allografts may fracture.

• Local recurrenceUncommon

  Despite adequate margins.

• DVT/PECommon

  Very high risk.

💉Anaesthetic Considerations

General anaesthesia. Major surgery with massive blood loss potential. Invasive monitoring. ICU bed booked.

🏃Recovery and Rehabilitation

ICU or HDU for 24–48 hours. Hospital stay one to three weeks. Weight-bearing depends on reconstruction — may be restricted for three to six months. Intensive physiotherapy. Walking aids long-term. Full rehabilitation twelve to eighteen months.

📅Follow-Up

Oncology surveillance with regular imaging. Reconstruction monitoring. Lifelong follow-up.

❓Frequently Asked Questions