Unique Cases

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Hip Disarticulation Hemipelvectomy Prosthetics

Unique Cases

A Step Ahead Prosthetics specializes in unique and/or difficult cases that other prosthetists will often turn away. The following is just a sampling of what we can do:

Van Ness Rotationplasty Prosthetics

Rotationplasty is a type of amputation is typically applied in cases of osteosarcoma (bone cancer) and congenital defects in the lower leg. The procedure involves a partial amputation of the leg above the knee. The lower leg and foot are rotated 180 degrees, the length is adjusted, and the tibia is then fused to the proximal femur. The foot is positioned where the knee used to be, with the heel portion in front and the toes pointing back. The ankle now functions in place of the knee joint. This creates a potential for greatly increased mobility for the patient as compared to a complete above-knee amputation.

However, in order for the patient to take full advantage of the benefits of a rotationplasty, it is crucial to have a properly-made prosthesis made by a prosthetist with experience in Van Ness patients. The rotationplasty prosthesis is radically different from any other type of prosthetic leg because it involves fitting the prosthesis to the patient’s reversed foot/ankle. A Step Ahead has worked with dozens of of recipients of this uncommon procedure and is currently considered the leader in prostheses for Van Ness Rotationplasties.

Hip Disarticulation Prosthetics

Hip disarticulation is the surgical removal of the entire lower limb at the hip level. It is most commonly indicated in cases of cancer, severe infection, or trauma. This uncommon amputation is not often seen by most prosthetists, and it is extremely important for the patient’s rehabilitation that the prosthetist have experience in fitting hip disarticulation prosthetics.

In hip disarticulation cases, there may be issues with a lack of weight-bearing surfaces, as well as the amount of soft tissue covering these surfaces. In addition, the size and shape of the amputation site for these patients tends to change more frequently than with other types of amputees.

A Step Ahead has established itself as a center of excellence in working with hip disarticulation amputees, both single and bilateral. We even helped one of our patients, a bilateral hip disarticulation, run the New York City Marathon!

A hemipelvectomy is a high level pelvic amputation. Along with hip disarticulations, hemipelvectomies are the rarest of lower extremity amputations. The procedure involves the amputation of half of the pelvis and the leg on that side. Hemipelvectomies may be required for several reasons, including cancer, severe infection, and trauma.

Since the patient lacks both a hip and half the pelvis, they are among the most difficult amputees to fit properly. There may be issues with a lack of weight-bearing surfaces, as well as the amount of soft tissue covering these surfaces. In addition, the size and shape of the amputation site for hemipelvectomy patients tends to change more frequently than with other types of amputees.

Hemipelvectomy patients are often told that they can not be fit for prosthetics. A Step Ahead, on the other hand, has successfully fit every single hemipelvectomy case we have been presented with. Our staff has considerable expertise in rehabilitating these amputees and getting them back on their feet.

Quadrilateral amputees – patients who have had portions of both arms and both legs – are exceedingly rare. The types and degree of amputation can differ from patient to patient, but A Step Ahead has experience in working with these amputees. Our staff is full aware of not just the physical considerations these amputees require, but the level of support and rehabilitation they will need.

Klippel–Trénaunay–Weber Syndrome is a rare congenital medical condition in which blood vessels and/or lymph vessels fail to form properly. The three main features are nevus flammeus (port-wine stain), venous and lymphatic malformations, and soft-tissue hypertrophy of the affected limb. Regarding limb hypertrophy, heel inserts are generally sufficient for limb discrepancies of 1.5 cm or less. For greater discrepancies, orthopedic surgery may be considered. Possible orthopedic procedures include osteotomy, epiphysiodesis, or epiphyseal stapling. Rarely, amputation is required due to recurrent infections, nonhealing ulcers, or recurrent bleeding.

A Step Ahead’s prosthetists have experience with creating prosthetics for KTS patients. In these cases, the large size of the affected limb makes fitting a challenging endeavor.


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