Rehabilitation and Functional Recovery After Hemipelvectomy: A Case Report of Successful Mobility Without an Anatomic Femoroacetabular Joint Articulation

Case Diagnosis: A 64-year-old female with an intermediate-grade left periacetabular chondrosarcoma.

Case Description or Program Description: The patient underwent a type 2 left hemipelvectomy with a left rotational flap and endoprosthetic reconstruction. After surgery, she was admitted to inpatient rehabilitation, where her mobility significantly improved. She was able to ambulate independently with a rolling walker and was discharged home after 14 days of intensive rehabilitation. However, 18 months later, the patient developed severe pain due to hardware failure from the initial hemipelvectomy procedure. She underwent hardware explantation with an osteotomy of the ilium and soft tissue rearrangement to provide support for the left hip joint. Afterward, she was readmitted to inpatient rehabilitation, where she regained independence with axillary crutches and a rolling walker.

Setting: Inpatient rehabilitation hospital

Assessment/Results: At 6 months post-revision surgery, she reports that her soft tissues have become stronger and are able to better support her weight. She utilizes a shoe lift to address her leg length discrepancy. While her mobility is limited by groin tightness and gluteal pain after prolonged activity, she is able to ambulate with a single axillary crutch within the home and typically uses 2 axillary crutches in the community. She attends physical therapy twice a week where she works on weight shifts, balance, strength, and endurance. Overall, her recovery has been smooth, and she is gradually increasing her activity level to regain independence.

Discussion (relevance): This case highlights the critical role of inpatient rehabilitation in enabling a patient to regain mobility and independence, even in the absence of a typical hip joint.

Conclusions: We present a rare case of a patient who underwent hemipelvectomy followed by hardware explantation due to post-operative complications. Despite the absence of a true femoroacetabular joint articulation, the patient maintained functional independence through intensive inpatient rehabilitation.