Pelvic support osteotomy and limb reconstruction for septic destruction of the hip

Joint instability and limb shortening due to septic destruction of the hip may not be correctable by reduction, fusion, or total joint arthroplasty. In these circumstances, a unique Ilizarov pelvic support osteotomy combined with reconstructive angular correction and lengthening of the limb can ameliorate Trendelenburg gait, restore knee alignment, and correct leg length discrepancy. Surgical reconstruction includes double-level femoral osteotomy resulting in 3 fragments (proximal, middle, and distal). Typically, the proximal osteotomy is a complex valgus-extension-derotation proximal femoral intertrochanteric or subtrochanteric osteotomy with adduction of the proximal fragment and proximal-medial translation of the distal segment to form a new weight-bearing surface between the pelvis and proximal femur (pelvic support). Distal osteotomy at the level of femoral diaphysis or distal metaphysis is used for gradual lengthening and angular correction of the position of the distal fragment to restore limb length and mechanical axis as well as correct associated angular deformity of the knee joint. This article describes the rationale and basic principles of Ilizarov pelvic support osteotomy and limb reconstruction using circular external fixation for septic destruction of the hip with an illustrative case example.