Hemipelvic amputations for recalcitrant pelvic osteomyelitis.
OBJECTIVE
To evaluate the outcome of recalcitrant deep pelvic infection that required a hemipelvic amputation.


METHODS
Retrospective cohort.


METHODS
Tertiary referral centre; Level I trauma.


METHODS
There were 20 patients with an infection of the pelvic girdle who developed life-threatening sepsis or had an intolerable existence due to putrefied tissues that prevented end of life care. All patients failed other more conservative treatments such as limited debridement and local wound care. The indication for amputation was life-threatening sepsis (eight patients), intolerable state with putrid tissue (four patients), and both sepsis/putrefaction (eight patients).


METHODS
A hemipelvic amputation, multidrug antibiotic treatment, and long-term suppression. Ten internal hemipelvectomies, eight external hemipelvectomies, and two hemicorporectomies were performed.


METHODS
Survival and recurrence of infection.


RESULTS
Six patients died within 6 months (mean time 17 weeks, range 2-24). The 14 surviving patients had a mean follow-up time of 28 weeks (9-48). Of these, 10 patients survived with no evidence of ongoing infection, and four patients had ongoing infection requiring suppressive antibiotics. All of the six deaths were in C-hosts with an average of six comorbidities each; mean age was 62 years old. Aetiologies of the infection were vasculopathy (5), spinal cord injury (4), post fracture (3), post abdominal surgery (2), gunshot wound (2), seeding from bacteraemia (4). Cierny-Mader host class was C (11) and B systemic/local (9) with an average of four (4) comorbidities each. Mean estimated blood loss=3100 cc and operative time=157 min. There were 11 cases of minor wound problems and no flap loss. Pathogens were polymicrobial (16 total pathogens) with mean of three per patient (most common was MRSA). Multi-agent antibiotic and suppression were used in all patients. In cases with putrefied tissues, appropriate nursing care was possible.


CONCLUSIONS
Patients requiring hemipelvectomies usually present with sepsis or an intolerable state. Despite expected complications, we found that hemipelvectomy is an effective palliative tool in selected cases. Age and vascular disease seemed to be associated with worse outcomes.
Ziran
Bruce H
BH
Department of Orthopaedic Trauma, St. Elizabeth Health Center, Northeast Ohio Universities College of Medicine, Youngstown, OH 44501, United States. Bruce_Ziran@hmis.org
Smith
Wade R
WR
Rao
Nalini
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006428:Hemipelvectomy / Q000379:methods* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D010166:Palliative Care / Q000379:methods; D010264:Paraplegia / Q000523:psychology; D010384:Pelvic Bones / Q000601:surgery*; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome; D014946:Wound Infection / Q000188:drug therapy* / Q000382:microbiology
D000900:Anti-Bacterial Agents