Authors: Zalavras CG, Rigopoulos N, Ahlman E, Patzakis MJ
Title: Hip Disarticulation for Severe Lower Extremity Infections
Institution: University of Southern California, LAC-USC Med Center, Los Angeles, CA
Purpose: Hip disarticulation is performed very rarely for infections, carries a high mortality rate, and surgeons may be reluctant to use it. This study describes hip disarticulation for management of severe infections and aims to determine the survival rate.
Methods: In this retrospective study we reviewed the medical records of patients that underwent hip disarticulation for the management of severe infections at our institution from 1994 to 2006. Eleven consecutive patients were identified (8 male and 3 female, mean age 42 years). Ten of eleven patients were compromised hosts and intravenous drug abuse was the most common comorbidity, present in 7 patients. The indications for hip disarticulation were necrotizing fasciitis in 6 patients, gas gangrene in 3 patients, and persistent severe infections of the proximal thigh in 2 patients: one patient sustained gunshot injuries to the involved lower extremity resulting in femoral vessel injury, sciatic nerve injury, muscle necrosis and abscess formation at the proximal thigh; another patient had an infected synthetic iliofemoral bypass graft. Polymicrobial infections were present in 8 patients and in 5 of these cases there was a combination of Gram positive, Gram negative, and anaerobic organisms.
Results: Hip disarticulation was performed emergently as a life-shaving procedure in 7 patients that presented in septic shock due to necrotizing infections and semi-electively, following previous debridement procedures, in 4 patients. All wounds were initially left open and were closed at a second procedure. All patients survived the operation and the hemodynamic status of all patients in septic shock significantly improved after the amputation. One patient with gas gangrene died 29 days following the procedure, therefore the survival rate was 91% (10/11) overall and 86% (6/7) when the procedure was performed emergently. The mean duration of hospitalization in the remaining 10 patients was 46 days (range, 24 to 107 days). At a mean follow-up of 4 months (range, 3 to 6 months) there was one wound infection that resolved after debridement.
Discussion and Conclusion: Hip disarticulation performed emergently for necrotizing infections resulted in stabilization of vital signs and high survival rates. Hip disarticulation is a viable option for management of severe lower extremity infections and should be part of the armamentarium of surgeons treating such infections.