Disarticulation of the lower extremity is removal of the leg at the hip joint, leaving the acetabulum intact. Historically, hip disarticulation was performed for lower extremity sarcomas. Currently, these conditions are often treated with limb-sparing procedures as a result of improvements in chemotherapeutic agents and radiotherapy. This has resulted in a decrease in the incidence of hip disarticulation. Many conditions that may have required a disarticulation in the past can now be treated with a high transfemoral amputation (above-knee amputation).

Typical indications for disarticulation of the lower extremity include unreconstructible vascular ischemia and infectious complications, often involving osteomyelitis in the setting of diabetes mellitus. Other situations requiring disarticulation include traumatic injuries, congenital disorders, and malignancy. A two-stage approach for grossly infected wounds with a more distal primary guillotine or open amputation to allow for improved source control prior to the definitive delayed proximal amputation may help to preserve limb length and improve the chance of postoperative wound healing.

The patient’s nutritional and physiologic status should be optimized to allow a milieu maximally conducive to wound healing. Should there be any concern regarding the patient’s ability to heal a hip disarticulation, especially in cases of vascular ischemia, alternative approaches should be considered (e.g., hemipelvectomy). Preoperative consultation with Physical and Rehabilitative Medicine as well as Psychiatry may be of benefit to the postoperative rehabilitation process.