What is the morbidity of hip dysarticulation?

Morbidity of Hip Disarticulation

Hip disarticulation is associated with extremely high morbidity rates, with wound complications occurring in approximately 60% of cases and a 5-year mortality rate as high as 55%, making it a procedure of last resort that should only be considered as a life-preserving measure when all other treatment options have failed. 1, 2

Indications and Clinical Context

Hip disarticulation (HD) is a radical lower extremity amputation performed by transecting all muscles and nerves surrounding the hip joint and separating the leg at the joint capsule. This procedure is typically reserved for:

• Life-threatening infections that fail other treatment modalities
• Severe limb ischemia
• Major trauma
• Malignancy
• Failed previous amputations with stump necrosis
• Septic joint with chronic osteomyelitis

Morbidity Factors

The morbidity associated with hip disarticulation is substantial:

• Wound complications: 60% overall incidence regardless of operative indication 2

  • Significantly increased by:
    • Urgent/emergent operations
    • Prior above-knee amputation

• Mortality rates: Overall 21%, ranging from 0% (tumor) to 50% (ischemia) 2

  • Significantly associated with:
    • Urgent/emergent operations
    • Presence of limb ischemia
    • History of cardiac disease

• Functional outcomes:

  • Most patients are limited to wheelchair mobility
  • Only about two-thirds of patients achieve successful wheelchair transfer 3
  • Prosthetic fitting results are generally poor 4

Risk Factors for Poor Outcomes

Several factors have been identified that significantly worsen outcomes:

• Peripheral vascular disease (particularly with failed revascularization)
• Presence of infection and ischemia simultaneously
• Urgent or emergent procedure (vs. planned)
• Prior failed lower limb amputations
• Cardiac comorbidities

Modern Approaches to Reduce Morbidity

Recent advances have attempted to reduce the high morbidity rates:

• Damage control hip disarticulation: A two-stage approach that:

  • Creates sufficient flap size in the initial procedure
  • Focuses on thorough postoperative wound care
  • Has shown improved survival rates in recent case series 3

• Patient selection: Careful consideration of:

  • Comorbidities (especially cardiac)
  • Vascular status
  • Infection burden
  • Previous surgical interventions

Clinical Pearls and Pitfalls

• Despite high morbidity, HD can be life-saving in appropriate circumstances
• Early detection of indications for HD may prevent further negative outcomes
• The presence of both infection and ischemia substantially increases mortality risk
• Age and diabetes mellitus alone do not appear to significantly influence mortality rates 2
• Postoperative care and rehabilitation are critical components of management

Hip disarticulation represents one of the most morbid procedures in orthopedic and vascular surgery, with substantial impact on quality of life, but may be necessary as a life-preserving measure in carefully selected cases where less radical approaches have failed.