Poster 153: Knee disarticulation in a patient with an ipsilateral girdlestone hip: a case report.

Abstract

Setting: Tertiary care medical center. Patient: A 66-year-old man with spindle cell sarcoma of the right lower-extremity requiring amputation. Case Description: The patient presented for preoperative consultation to an outpatient amputee clinic on an appropriate level of amputation to achieve best functional outcome. He had a Girdlestone hip on the ipsilateral side of the sarcoma. Due to the proximity of the sarcoma to the knee, a below-knee amputation was not an option. The patient suffered from multiple comorbidities, including diabetes, peripheral vascular disease, and degenerative joint disease. Preoperatively, the patient was an independent household ambulator, but used a wheelchair for longer distances. He was independent with transfers, toileting, and activities of daily living. The patient’s goal was to continue ambulation after the amputation. We recommended a knee disarticulation for the following reasons: a longer residual limb provides a better base of support for sitting, a longer lever arm is better for transfers, and less energy is expended during gait as compared with hip disarticulation or above-knee amputation. Regarding prosthetic fitting issues, the knee disarticulation would provide greater stability with the longer residual limb and partial distribution of weight bearing at the femoral condyles. Assessment/Results: The patient underwent a knee disarticulation without complication. The prosthesis included an ischial containment socket with a manual locking knee. Inpatient rehabilitation was planned for gait training. Discussion: This is the first reported case, to our knowledge, of a knee disarticulation with an ipsilateral Girdlestone hip. Conclusion: This exemplifies the importance of physiatric preoperative functional assessment, with attention to patient goals and consideration of prosthetic-fitting issues.