This guide serves as a gateway to various resources to help with both pre-surgery preparation and post-surgery recovery for hip disarticulation and hemipelvectomy (also known as transpelvic amputation). These procedures are complex and present many physical and emotional challenges. But there is help available.
In this video from six years ago, YouTuber Crystal D showcases the first hip disarticulation prosthetic she received after her operation:
Her videos since have seen her get back into horseback riding and becoming a mom (twice!). Having a solid support network in place can help overcome any hurdle.
For answers to questions not covered here, we encourage you to access our Support Group Network. Access one of our 400+ support groups registered with the Amputee Coalition accross the U.S. to receive vital support on your journey.
When is Hip Disarticulation or Hemipelvectomy Performed?
A hip disarticulation is an amputation of the leg right at or just below hip level. It is performed as a result of a traumatic accident, cancer, infections or complications from diabetes. A hemipelvectomy also involves the removal of part of the pelvic bone and can be performed for those same causes, along with instances of spinal cord injury or recurring severe ulcerations and infections.
Surgery Preparation and Recovery
Hip Disarticulation and Hemipelvectomy are complex procedures, and the road to recovery and successful prosthetic use takes time. With a dedicated care team and the right supports, you or your loved one will be able to quickly recover from the procedure and learn to get back to living their life.
The patient and family will ideally consult with each member of the surgical and rehabilitation team. This team will fully explore the surgical process with the patient, and also explain how rehabilitation will work post-surgery.
Another important step is choosing a prosthetist. The patient will be working a lot with this individual over the first year after surgery (and ideally forming a long-term relationship with them beyond that), so it makes sense to choose someone they trust. You can visit our ProsthetistFinder to seek out a professional who meets your needs.
Since this amputation level is performed close to the lower torso, people who undergo these procedures will face unique challenges from other levels of leg amputation.
No two people’s amputation journeys will be the same, and this is particularly true of hip disarticulation and hemipelvectomy.
Unlike other leg amputations where the surgeon has some leeway as to where to amputate for better biomechanical outcomes, the lower trunk offers very little room for compromise. The bone must be shaped for weight-bearing while sitting and standing, and muscles from the buttock or thigh shaped to form the flap – and the lack of access tissue can lead to the need for additional skin grafts.
Both procedures (particularly hemipelvectomy) may also impact organs in the area dependent on the level of amputation required.
There are also bodily functions that may be impacted by this surgery including:
Bladder and bowel function
Washroom habits may be impacted by the surgery since the organs are so close to the area of amputation. The frequency of needing to use the bathroom may be affected, and it’s common in the case of hemipelvectomy to have had a colostomy as part of the procedure. In this case, the prosthetic socket will be fitted with an opening to facilitate the use of a colostomy bag.
It is still possible for women to carry a child and give birth naturally after undergoing hip disarticulation or hemipelvectomy, though they may have to stop wearing their prosthetic as the baby grows to avoid putting pressure on the fetus. Those with hemipelvectomy are at higher risk due to the lack of a full pelvic bone structure to support the fetus – it is important to consult with a doctor early and follow their advice.
Recovery and Rehabilitation
The first day after surgery can be one of the most difficult. What was previously just an idea is now a reality. It is important to remember, however, that big changes also present new beginnings and opportunities.
The human hip is integral to standing, walking, and sitting – the loss of three weight-bearing joints means a huge adjustment to mobility, and it’s good to go into the rehabilitation process with a flexible mindset. It will take plenty of time and hard work before you can stand or even sit comfortably on your own – but with the right support, you will soon be back to living a fulfilling life.
The pelvic area will be treated with special compression bandages to help heal the wound quickly. This will also help prepare for wearing a prosthesis. The team will also advise on how to wash and take care of the residual limb.
A rehab team will likely include doctors, physical and occupational therapists, nurses, and a prosthetist. Rehab will begin shortly after the surgery to work on upper body strength and learning how to do day-to-day activities with and without a prosthesis. Overall, rehab could take anywhere from a few months to over a year.
When the residual limb is healed, the pelvic area will be cast using plaster or 3D imaging to create a test socket for a prosthesis. During rehab, a temporary prosthesis will be used and the prosthetist will assess the fit during exercises to determine if the socket needs to be readjusted.
Exercises performed with a temporary prosthesis include:
- How to put on and take off the prosthesis
- Learning to walk with on a level surface
- Learning to walk up and down ramps and stairs
- Sitting down or standing up
- Fall training
When the swelling in the residual limb has fully gone down and the patient enters the last phase of rehab, a permanent prosthetic can start to be worn.
The road to recovery may also include navigating phantom pain, which you can learn more about here.
It is normal to go through some level of depression when working through the massive changes that come with losing a limb. A counselor may or may not have been assigned as a part of the rehabilitation team to help work through these difficult emotions. It is important to recognize the signs of depression and remember that others have gone through many of these same feelings. If you need help, don’t be afraid to ask for it.
For more information be sure to read our guide on how to cope with the loss of a limb.
It may also help to speak with another amputee before the procedure to put your mind at ease. Amputee Coalition is connected with thousands of Certified Peer Visitors across the United States. We connect new amputees with someone who has gone through amputation to help with both preparation and the road to recovery.
Hip disarticulation and hemipelvectomy prosthetics are designed with hip, knee and foot joints that replicate the biomechanical functions of a biological leg and hip. Prosthetics come in all shapes and sizes to suit the needs and desires of each unique individual.
Losing a leg at the hip level means that there is no lever to control a prosthesis, and the learning curve for movement with a prosthesis is long. Many wearers will in time be able to get around on a prosthesis without canes or crutches, but some may need to use them beyond rehab.
The socket for a hip disarticulation or hemipelvectomy prosthesis is a “total embracing socket” that is cast from the wearer’s pelvis and made to bear the user’s weight. The socket is kept in place using a strap around the waist, and a shoulder strap may be added for additional suspension.
One major consideration is the type of underwear worn – it is important that the fabric is taut where the prosthetic connects to the body. There are prosthetic socks/stockinets available, though many people simply modify existing clothes to suit their needs.
Here are some of the component options to look at in prosthetics:
Hip Components and Joints
- Hip Limiter: Controls the amount of step length and prosthetic movement in the hip swing phase. It can be adjusted as the wearer becomes more active over time.
- Interjoint Segment: Allows for faster motion and less energy usage by releasing energy from the hip during a step.
- Polycentric Hip Joint: Also referred to as “four-bar” joints. It provides a smooth walking pattern by closely mirroring the range of motion of a biological hip.
Prosthetic Knee Options
- Single-axis knees: hinge-style knees that can only bend forward and backward. Above-knee. Rotators can be added to allow the wearer to rotate the lower part of their prosthesis.
- Polycentric knees: also referred to as “four-bar” knees, can rotate on multiple axes.
- Microprocessor knees: uses sensors to detect changes in walking speed, surface type, grade, and terrain. The knee quickly adjusts the resistance to flexion and extension to accommodate.
Resuming an Active Lifestyle and Day-to-day Activities
As rehabilitation progresses, most day-to-day activities can be resumed. While there will be an adjustment period, the patient will soon be able to do most everything they could prior to amputation.
Exercise and Sports
As strength is recovered, many physical activities can be resumed with some modification, with or without a prosthesis. There are also dozens of adaptive sports and leagues available for people of all abilities.
Driving a Car
Driving a car with your left leg is possible, or even with no legs. Modified foot or hand controls are available for various car models to maintain independence and get around without assistance.
Learn more about how to drive with various levels of amputation here.
Perhaps one of the hardest challenges to navigate after amputation is socializing with friends, family, and others. The patient may perceive that they are helpless, or that they are being treated differently.
To help process those feelings, consider accessing one of our 400 registered Limb Loss Support Groups. These groups allow you or your loved one to express your feelings amongst other amputees and can help provide you with the tools to help navigate these new social situations.
Request More Resources on Amputation
We hope this guide has provided you with the knowledge you need to get through this challenging time. You likely still have many questions.
Be sure to check out our hip disarticulation and hemipelvectomy resources section for more information on various topics:
At Amputee Coalition, our mission is to make sure that no one going through limb loss feels alone. Along with our peer visitor program, we offer plenty of services and support for those who will soon be undergoing amputation or already have.
For free, personalized resources and information about how to access all of our services, reach out to one of our dedicated information specialists.
Featured Image Credit: Prosthetic & Orthotic Associates.