Pelvic reconstruction surgery is often needed for a severe pelvic fracture, after the resection of larger tumours or for destructive osteolytic processes in the pelvis and hip region which leave these bones softer and more prone to fractures. It may also be due to severe trauma like a car accident. While this type of surgery is extensive, involving the replacement of a part of the pelvis with a total hip replacement and, in some cases a partial replacement of the femur, pelvic reconstruction is often the best suitable option other than amputation (hemipelvectomy). With the reconstruction of the pelvis and a hip replacement, mobility can be ensured for the next 20 odd years.
How is a pelvic reconstruction done?
A pelvic reconstruction usually involves reconstruction or replacing the part of the pelvis which may have been fractured, removed during a tumour resection or damaged by osteolysis with prosthetic components made from metal, ceramic, and plastic.
The size of the incision will depend on the type of fracture. It may be one of the following types of fractures:
- Horizontal (known as a transverse fracture)
- Angled (known as an oblique fracture)
- Comminuted - the bone has shattered into fragments
Dr Nhlapo will be able to tell using the x-rays what approach he would need to take in surgery and whether custom prosthetics may be needed. To begin the pelvic reconstruction, he will make an incision and reassemble the broken fragments and using a fixation device to keep the bone fragments in position while the bone heals. This fixation device may be internal or external depending on the location and severity of the fracture. In some cases, the pelvis may be fractured in many places which may require custom-built implants. If this is the case, the damaged parts of the pelvis will be replaced with prosthetic parts before a hip replacement is done.
If the acetabulum has also been damaged, Dr Nhlapo will also do a hip replacement. During a hip replacement surgery, the damaged femoral head is then cut out and removed. Next, the damaged cartilage of the socket (the acetabulum) is removed, and the bone is shaved away leaving the socket ready for the new acetabular component. This component is wedged into the bone and over time, the implant and bone with fuse together. The femur is then hollowed out to make space for the femoral stem implant which is placed into the bone. After the hip is connected and the pelvis is reconstructed, Dr Nhlapo will make sure that the joint is stable and flexing correctly before closing the incision.
What can I expect in terms of recovery?
Your orthopaedic surgeon will discuss the outcome of surgery as well as the recovery process in detail with you once you wake up from anaesthesia. Of course, because this is an extensive surgery swelling, pain and stiffness of the lower half of the body are to be expected. Dr Nhlapo will, however, try to make your recovery as comfortable as possible. With the help of a physiotherapist in the next few weeks, you will do exercises to strengthen and enhance the mobility of the hip joint and pelvis. You will need to make some lifestyle changes after surgery including avoiding high impact activities such as running, jogging and jumping. Your recovery process will depend on how severe the fractures were and what surgeries were done as treatment, but full recovery may take up to a year.