Abstract
Background
Advances in diagnosis and treatment should mean that hindquarter amputation is now rarely needed. Unfortunately this is not the case. We have performed 166 of these amputations in the past 36 years. We have investigated the reasons why this procedure is still required and the outcomes following it.
Method
A retrospective review of data stored on a prospective database.
Results
Hindquarter amputation was used as treatment for 15% of all primary bone tumours affecting the pelvis. 146 were performed with curative intent but 20 were performed purely for palliation, usually to relieve pain. 96 of the procedures were needed as part of primary treatment, with the other 70 being needed following failure of local control after other surgical procedures. The indication for amputation in primary disease was almost always due to a significant delay in diagnosis, allowing tumours (particularly chondrosarcomas) to become massive by the time of diagnosis. The peri-operative mortality was 3% and 45% had major wound healing problems or infection. The median survival times after curative and palliative procedures were 36 months and 8 months respectively. The survival after hindquarter amputation for curative intent at 1, 3 and 5 years was 74%, 60% and 48%.
Overall survival was better with chondrosarcoma – 52% of the patients surviving more than 10 years had chondrosarcoma. Phantom pain was a significant problem; fewer than 10% use their prosthesis regularly. Despite this functional scores averaged 61% – not significantly worse than patients who had undergone pelvic replacements!
Conclusion
Hindquarter amputation is still regularly required both for primary and salvage treatment in musculoskeletal oncology. Earlier diagnosis of pelvic tumours may avoid its use. Survival is not surprisingly worse than for tumours at other sites.
