Hip Amputation

Hip Disarticulation / Boyd Technique 


Anterior Racquet shaped incision

- begins just inferior to ASIS

- curves medially to under inguinal ligament

- 5 cm distal to adductor origin


Identify and ligate femoral artery and vein


Posterior incision

- 5 cm beneath ischial tuberosity

- laterally 8 cm below greater trochanter 

- then curve back to ASIS


Superficial Dissection

- detach sartorius & rectus femoris proximal

- divide pectineus 1/2 inch from the pubis

- avoid division of obturator vessels from where exit pelvis


Anterior Deep Dissection

- ER leg

- divide iliopsoas tendon at LT

- detach adductors & gracilis at ischium

- expose and ligate obturator artery / nerve between pectineus & obturator externus at femur


Posterior Deep Dissection

- IR leg

- divide obturator externus / short external rotators at femur

- detach G max & G med from femur

- divide G max in line of skin incision



- disarticulation

- divide capsule & L Teres

- divide hamstrings at ischium


Muscle flaps

- suture gluteal flap to pectineus & adductor muscles 

- approximate skin edges


Hindquarter Amputation



- hemipelvectomy

- trans-iliac /trans-pelvic amputation


Set Up

- two surgeons 

- colostomy & stitch anus closed

- eschmarc to express limb of blood to prevent shock

- cross match 3 L of blood

- prepped from chest to below knees

- tape scrotum to opposite leg

- special frame to hold leg 

- lateral with amputated limb up


3 Part Technique King & Steelquist


Anterior Part

- begin incision at pubic tubercle

- extend along inguinal ligament to ASIS

- extend along crest to PSIS 

- detach abdominal muscles & inguinal ligament from the crest 

- open iliac fossae between peritoneum & iliacus

- at the pubis severe the inguinal ligament & the rectus abdominis & retract the cord medially

- open the space of retzius & retract the bladder into the pelvis

- divide external iliac artery and vein & femoral nerve


Perineal Part

- widely abduct the leg

- extend the incision from the pubic tubercle, along the pubic & ischial rami to the ischial tuberosity

- expose the subcutaneous rami

- elevate the ischiocavernosus & transversus perinei subperiosteally from the rami inferior surfaces

- divide symphysis pubis with osteotome


Posterior Part

- carry incision from PSIS to GT then along gluteal crease to ischial tuberosity 

- expose G max aponeurosis in line with the skin incision 

- elevate G max, forming a large flap of skin, fat & muscle

- expose G medius & short rotators into view 

- sever piriformis & sciatic nerve

- pass gigli saw through greater sciatic notch & bring it out over iliac crest just anterior to SIJ

- divide ilium, sacrotuberous & sacrospinous ligaments

- rotate inominate bone with leg to expose pelvic contents

- divide obturator artery and vein

- divide psoas at SIJ

- divide levator ani off pelvic wall

- hemipelvis now free



- suture G max flap to rectus abdominus / lateral abdominal wall / quadratus lumborum / psoas

- close skin over drains

- firm dressing