Mirgos MP, Wrześniak Z, Pulik Ł, Górski R, Łęgosz P. Restoration of ambulation after internal hemipelvectomy using a three-stage reconstructive strategy: A case report and review of literature. World J Orthop 2026; 17(7): 121971 [DOI: 10.5312/wjo.121971]
Corresponding Author of This Article
Paweł Łęgosz, MD, PhD, Professor, Department of Orthopedics and Traumatology, Medical University of Warsaw, William Heerlein Lindley Street 4, Warsaw 02-005, Mazowieckie, Poland. pawel.legosz@wum.edu.pl
Research Domain of This Article
Orthopedics
Article-Type of This Article
case-report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Mirgos MP, Wrześniak Z, Pulik Ł, Górski R, Łęgosz P. Restoration of ambulation after internal hemipelvectomy using a three-stage reconstructive strategy: A case report and review of literature. World J Orthop 2026; 17(7): 121971 [DOI: 10.5312/wjo.121971]
World J Orthop. Jul 18, 2026; 17(7): 121971 Published online Jul 18, 2026. doi: 10.5312/wjo.121971
Restoration of ambulation after internal hemipelvectomy using a three-stage reconstructive strategy: A case report and review of literature
Maciej Piotr Mirgos, Zofia Wrześniak, Łukasz Pulik, Radosław Górski, Paweł Łęgosz
Maciej Piotr Mirgos, Zofia Wrześniak, Faculty of Medicine, Medical University of Warsaw, Warsaw 02-091, Mazowieckie, Poland
Łukasz Pulik, Radosław Górski, Paweł Łęgosz, Department of Orthopedics and Traumatology, Medical University of Warsaw, Warsaw 02-005, Mazowieckie, Poland
Co-corresponding authors: Maciej Piotr Mirgos and Paweł Łęgosz.
Author contributions: Mirgos MP designed the study; Mirgos MP and Wrześniak Z performed the literature analysis and drafted the manuscript; Wrześniak Z collected and described the patient’s clinical data; Pulik Ł and Łęgosz P proofread the manuscript and supervised the study process; Górski R contributed to the description and interpretation of the Ilizarov technique; Mirgos MP and Łęgosz P are co-corresponding authors, Mirgos MP was responsible for the manuscript preparation and submission, while Łęgosz P provided the clinical supervision and revised the manuscript, their complementary contributions justify the co-corresponding authorship. All authors have read and approved the final manuscript.
AI contribution statement: AI tools (specifically ChatGPT, OpenAI) were used solely for language polishing and formatting assistance to improve readability and conformity with the journal’s structural and editorial requirements. No AI tools were used in the development of the study design, data collection and analysis, interpretation of results, or formulation of conclusions. No images or figures included in this manuscript were generated by AI. All AI-assisted outputs were carefully reviewed and validated by the authors. The authors take full responsibility for the accuracy and originality of the manuscript, in accordance with the recommendations of the International Committee of Medical Journal Editors and the Committee on Publication Ethics.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Paweł Łęgosz, MD, PhD, Professor, Department of Orthopedics and Traumatology, Medical University of Warsaw, William Heerlein Lindley Street 4, Warsaw 02-005, Mazowieckie, Poland. pawel.legosz@wum.edu.pl
Received: April 7, 2026 Revised: May 3, 2026 Accepted: June 4, 2026 Published online: July 18, 2026 Processing time: 96 Days and 6.2 Hours
Abstract
BACKGROUND
Internal hemipelvectomy profoundly alters pelvic biomechanics, often resulting in complex, multilevel deformities, including limb-length discrepancy, joint instability, and gait dysfunction. Management of complex late sequelae remains challenging. This report describes a staged reconstructive strategy used to improve ambulation in a patient with severe post-oncological deformities.
CASE SUMMARY
A 16 years old boy presented with severe deformities following childhood type I pelvic resection for Ewing sarcoma. Findings included a 10 cm limb length discrepancy, valgus malalignment, equinus contracture, and common peroneal nerve palsy. Imaging revealed pelvic deformity, acetabular dysplasia, and proximal femoral asphericity. A threestage management plan was implemented: (1) Ilizarov distraction osteogenesis, achieving 7.5 cm of tibiofibular lengthening; (2) Custom-made pelvic implant reconstruction with total hip arthroplasty; and (3) Correction of equinus deformity with additional lengthening and Hoke tenotomy. This strategy resulted in substantial improvement in limb alignment, weight-bearing capacity, and ambulatory function, although gait remained abnormal at final follow-up.
CONCLUSION
Sequential biological-prosthetic reconstruction may improve functional ambulation after internal hemipelvectomy in select patients.
Core Tip: Internal hemipelvectomy may lead to severe biomechanical disturbances that compromise gait and mobility. This report describes an uncommon case of long-term functional impairment following pelvic tumor resection that was successfully managed using a three-stage reconstructive strategy. Sequential use of distraction osteogenesis, custom pelvic reconstruction with total hip arthroplasty, and distal deformity correction resulted in significant improvement in ambulation. This case highlights the potential value of staged biomechanical optimization before definitive reconstruction in selected orthopedic oncology patients.
