Emergency hip disarticulations for severe necrotising fasciitis of the lower limb: a series of rare cases from a rural district general hospital

Abstract

Hip disarticulation is the removal of the entire lower limb through the hip joint by detaching the femur from the acetabulum. This major ablative procedure is rarely performed for infection but may be required in severe necrotising fasciitis. We present a single centre retrospective review of all cases of emergency hip disarticulations in patients with necrotising fasciitis between 2010 and 2020. All five patients included in the review presented with acute lower limb pain and sepsis. Three patients had comorbidities predisposing them to necrotising fasciitis. Three were deemed to be high risk and two were at intermediate risk of developing necrotising fasciitis. There were two deaths in the postoperative period. Of the three survivors, two required revision surgery for a completion hindquarter amputation and one for flap closure. All three survivors had good functional outcomes after discharge from hospital. Despite its associated morbidity, emergency amputation of the entire lower limb is a life-saving treatment in cases of rapidly progressing necrotising fasciitis and should be considered as a first-line option in managing this condition.

Keywords: Debridement; Disarticulation; Hemipelvectomy; Necrotising Fasciitis.

Figure 1

X-ray of left femur (patient 3) demonstrating extensive abnormal distribution of air in the subcutaneous tissue plane

Figure 2

Computed tomography axial slices (patient 4) showing subcutaneous inflammation and muscular oedema of the right lower limb

Figure 3

Computed tomography coronal slices (patient 5) showing subcutaneous inflammation and oedema of the soft tissue and muscles of the left lower limb