Retrospective analysis of mortality and quality of life after hip disarticulation or hemipelvectomy: a report on 15 patients,Archives of Orthopaedic and Trauma Surgery

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Retrospective analysis of mortality and quality of life after hip disarticulation or hemipelvectomy: a report on 15 patients
Archives of Orthopaedic and Trauma Surgery ( IF 2.0 ) Pub Date : 2023-02-01 , DOI: 10.1007/s00402-023-04783-4
Melanie Schindler ₁ , Susanne Baertl ₁ , Nike Walter ₁ , Siegmund Lang ₁ , Dominik Szymski ₁ , Volker Alt ₁ , Markus Rupp ₁

Affiliation

Background

Hip disarticulation and hemipelvectomy are defined as major ablative amputations of the lower limb. Due to the small number of patients, little is known about the outcome and follow-up.

Aims

We aimed to assess (1) reasons for performed major ablative surgeries such as hip disarticulation and hemipelvectomy in a German center for trauma and orthopedic surgery. (2) In addition, mortality and quality of life after hip disarticulation and hemipelvectomy as well as (3) patient and treatment characteristics should be investigated.

Methods

During a period of twelve years, 15 patients underwent hip disarticulation or hemipelvectomy. Mortality, EQ-5D-3L quality of life by EQ-5D-3L and time-trade-off (TTO), VAS, cause of disarticulation, length of hospital stays, revisions, comorbidities, Charlson comorbidity index (CCI), and ASA score were evaluated retrospective for all patients.

Results

The overall mortality rates were 26.7% at 30 days, 60.0% after one year and 66.7% after three years. The five surviving patients reported about moderate problems in the EQ-5D-3L. The average VAS score reached 45 (range 15–65). The mean TTO was 9.8 (range 6–12). Indications for amputation were infection (n = 7), tumor (n = 6), trauma (n = 1) and ischemia (n = 1).

Conclusion

Hip disarticulation and hemipelvectomy are followed by a high postoperative mortality. Quality of life of the affected patients is impaired in long-term follow-up. Especially amputations performed due to infections show high mortality within one month after surgery despite average young age and low CCI. Surgeons should be aware of this devastating outcome and extraordinary vigilant for these vulnerable patient cohorts.

中文翻译：

髋关节离断或半骨盆切除术后死亡率和生活质量的回顾性分析：15例患者的报告

背景

髋关节离断术和半骨盆切除术被定义为下肢的主要消融性截肢术。由于患者数量较少，对结果和随访情况知之甚少。

目标

我们的目的是评估 (1) 在德国创伤和骨科手术中心进行髋关节离断术和半骨盆切除术等主要消融手术的原因。(2) 此外，应调查髋关节离断术和半骨盆切除术后的死亡率和生活质量以及 (3) 患者和治疗特征。

方法

在 12 年的时间里，15 名患者接受了髋关节离断术或半骨盆切除术。死亡率、EQ-5D-3L EQ-5D-3L 的生活质量和时间权衡 (TTO)、VAS、离断原因、住院时间、翻修、合并症、查尔森合并症指数 (CCI) 和 ASA对所有患者进行回顾性评分。

结果

30天时的总死亡率为26.7%，一年后的总死亡率为60.0%，三年后的总死亡率为66.7%。五名幸存患者报告 EQ-5D-3L 存在中度问题。VAS 平均分达到 45 分（范围 15-65）。平均 TTO 为 9.8（范围 6-12）。截肢指征包括感染（n = 7）、肿瘤（n = 6）、创伤（n = 1）和缺血（n = 1）。