Title: Is hip disarticulation for bone and soft tissue sarcomas still justified in modern era of treatment?
Authors: Vikas Warikoo, Nikhil Garg, Abhijeet Ashok Salunke
DOI: https://dx.doi.org/10.18535/jmscr/v7i9.128
Abstract
Background: Hip disarticulation is the radical amputation of the lower limb through the hip joint. Hip disarticulation is a treatment modality tumours with neurovascular encasement and non-responsive to chemotherapy.
Patients & Methods: The study included 38 retrospective cases of patients who were operated in our institute with hip disarticulation for bone and soft tissue sarcoma from 2013 to 2018. Patients were analysed by tumour type, extent of disease and intent of surgical intervention (curative, curative/palliative, palliative). Disease free survival (DFS) and post-operative overall survival (OS) were calculated from the time of surgery to the last follow-up or date of death.
Results: The median DFS for all patients was 12 months, the median OS was 17 months and one year survival rate was 63.88%. When this manuscript was drafted, only 42% of the patients in the sample were alive.
Conclusion: Hip disarticulation is a major surgical procedure and proper planning is required. Hip disarticulation will continue to feature in the sarcoma surgeon’s armamentarium for unresectable tumours.
Keywords: Hip disarticulation, bone sarcoma, soft tissue sarcoma, survival rate.
References
- Karakousis CP. The technique for major amputations for malignant tumours. J Surg Oncol 1983;23:43–55.
- Kirk NT. Amputations. Hagerstown, MD: WFPrior Co.; 1943.
- Westbury G. Hindquarter and hip amputation. Ann R Coll Surg Engl 1967;40:226–34.
- Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ. Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. A long-term oncological, functional, and quality-of-life study. J Bone Joint Surg Am 1994;76:649–56.
- Renard AJ, Veth RP, Schreuder HW, van Loon CJ, Koops HS, van Horn JR. Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. Surg Oncol 2000;73:198–205.
- Abudu A, Sferopoulos NK, Tillman RM, Carter SR, Grimer RJ. The surgical treatment and outcome of pathological fractures in localised osteosarcoma. J Bone Joint Surg Br 1996;78:694–8.
- Denes Z, Till A. Rehabilitation of patients after hip disarticulation. Arch Orthop Trauma Surg 1997;116:498–9.
- Jain R, Grimer RJ, Carter SR, Tillman RM, Abudu AA. Outcome after disarticulation of the hip for sarcomas. Eur J Surg Oncol.2005;31(9):1025–8
- Daigeler A, Lehnhardt M, Khadra A, Hauser J, Steinstraesser L,Langer S, et al. Proximal major limb amputations – a retrospective analysis of 45 oncological cases. World J SurgOncol. 2009;7:15.
- Ebrahimzadeh MH, Kachooei AR, Soroush MR, HasankhaniEG, Razi S, Birjandinejad A. Long-term clinical outcomes of war-related hip disarticulation and transpelvic amputation. JBone Joint Surg Am. 2013;95(16):e114, 1-6.
- Nowroozi F, Salvanelli ML, Gerber LH. Energy expenditure in hip disarticulation and hemipelvectomy amputees. Arch PhysMed Rehabil. 1983; 64(7):300–3.