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Hemipelvectomy: keeping the leg or removing it | CION Cancer Clinics
In an internal hemipelvectomy, part of the pelvic bone is removed with the tumour and the leg is kept. In an external hemipelvectomy, the leg is removed along with that half of the pelvis. The choice depends mainly on whether the main nerve and blood vessels to the leg are free of tumour. This page compares both, and what to ask. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is the difference between internal and external hemipelvectomy?
- How do the two operations compare?
- Which part of the pelvis can be removed while keeping the leg?
- How does the team decide between them?
- What does recovery look like after each?
- What do families often believe about these operations?
- What should you ask your surgeon?
- Common questions about internal and external hemipelvectomy
The short answer
What is the difference between internal and external hemipelvectomy?
In an internal hemipelvectomy, part of the pelvic bone is removed with the tumour, but the leg is kept. In an external hemipelvectomy, the leg is removed together with that half of the pelvis. Both are done to take out a tumour of the pelvis in one piece.
Why the leg is sometimes kept and sometimes not
The leg can be kept when the main nerve and blood vessels to it can be separated safely from the tumour, and when enough muscle and skin remain to cover the area. When the tumour wraps around those structures, keeping the leg would mean leaving tumour behind, or leaving a leg that does not work and cannot heal.
Why it matters to understand both
Many families assume that keeping the leg is always the goal. Often it is. But an internal operation that leaves a painful, useless leg or keeps coming back as infection can be harder to live with than a planned external one. The team weighs the tumour, the nerves and vessels, your general health and what you want from daily life.
What this page cannot tell you
It cannot tell you which operation you need. Only your own scans and a team that treats pelvic tumours regularly can say that.
Side by side
How do the two operations compare?
Internal hemipelvectomy
External hemipelvectomy
Part of the pelvis removed, the leg kept
Half the pelvis removed along with the whole leg
Possible when the main nerve and vessels can be kept free of tumour
Chosen when the tumour involves them, or the leg could not survive
May need an implant, bone graft or hip reconstruction
No bone reconstruction, but a large skin flap closes the wound
Walking often with a limp, stick or crutches
Walking with crutches, an artificial leg, or a wheelchair
Implant problems or infection may need further operations
Phantom sensations and pain in the missing leg are common
Internal operations
Which part of the pelvis can be removed while keeping the leg?
Surgeons describe an internal hemipelvectomy by the zone removed. Your report may use these labels.
The wing of the hip bone
The broad upper part of the pelvis, called the ilium. The hip joint is kept. Walking is often good afterwards, sometimes after a bridge is rebuilt to the spine.
Usually labelled Type I.The hip socket
The acetabulum, where the thigh bone sits. Removing it is the hardest on walking. The hip may be rebuilt with an implant, or the thigh bone allowed to settle into scar tissue.
Often means
- A shorter leg
- Long rehabilitation
The front of the pelvis
The pubic and sitting bones at the front and bottom of the ring. The hip is kept, and walking is usually affected least. A hernia-type bulge may need repair with mesh.
Usually labelled Type III.Extending into the sacrum
When the tumour crosses into the sacrum, part of it is removed too. The spine may then need to be fixed to the remaining pelvis with rods and screws.
Not sure whether this applies to you?
Ask an oncologistMaking the decision
How does the team decide between them?
The decision rests on the scans, the biopsy and you. No page can make it for a particular person, and no good team makes it in a hurry.
What the team weighs
They look at whether the sciatic nerve, the main nerve to the leg, and the large blood vessels can be kept free of tumour. They look at how much muscle and skin will remain, whether radiotherapy has already been given, and how the tumour has responded to chemotherapy. Your fitness, weight and other illnesses also count.
Who an internal operation may not suit
If the leg would be left without its main nerve, or the wound is unlikely to heal after heavy radiotherapy, keeping the leg may bring repeated infections and operations. Someone who wants the most predictable recovery may lean towards an external operation in that situation.
Who an external operation may not suit
If the tumour can be removed with a clear margin while keeping a working leg, removing the leg gives up function without a clear gain in tumour control. A second opinion at another pelvic tumour centre is reasonable before any amputation.
Ask your surgeon to explain why the other operation was not chosen. That answer tells you a great deal.After the operation
What does recovery look like after each?
-
Intensive care and the first days
Both operations are long and involve blood loss. Most people spend the first days in intensive care or a high-dependency bed, with drains, a catheter and strong pain relief.
-
The wound
Wound healing is the main worry after either operation. The team watches for fluid, infection and skin breakdown, and some people need a return to theatre.
-
Getting up
After an internal operation, weight on the leg is often limited for weeks. After an external one, you learn to balance and move with a frame or crutches.
-
Rehabilitation
Physiotherapy continues for months. After an external operation, a fitting for an artificial leg may be discussed once the wound has healed. Many people choose crutches or a wheelchair instead.
-
Follow-up
Regular scans check for the tumour coming back and, after an internal operation, for problems with any implant.
Commonly believed
What do families often believe about these operations?
"Keeping the leg is always the better result."
A working leg is a real gain. A leg without its main nerve, with repeated infections, can be a heavy burden. The right choice depends on what the leg will be able to do.
"After an external hemipelvectomy, life is
over."
People return to home life, work and travel after this operation. It is a very large change, and it takes counselling, rehabilitation and time. It is not the end of an independent life.
"Everyone gets an artificial leg and walks
normally."
An artificial leg after this operation is heavy and takes a lot of energy to use. Many people try one, and many settle on crutches or a wheelchair for daily life.
"Choosing amputation means the cancer was worse."
The choice is about where the tumour sits in relation to nerves and vessels. It does not on its own tell you how serious the cancer is.
Before you decide
What should you ask your surgeon?
- Can the main nerve and vessels to the leg be kept free of tumour?
- What will my leg be able to do if it is kept?
- Why was the other operation not recommended?
- Will I need an implant, and what happens if it fails?
- Who will fit and train me for an artificial leg, if I want one?
- Can I speak to a counsellor before I decide?
Questions we are asked
Common questions about internal and external hemipelvectomy
Is an internal hemipelvectomy safer than an external one?
Not simply. Both are major operations with real risks. An internal operation keeps the leg but can bring implant problems and further surgery. An external operation avoids implants but brings the loss of the leg and phantom pain. Your surgeon should explain the risks of each for you.
What is phantom limb pain?
It is pain or other sensations that feel as if they come from the leg that was removed. It is common after amputation and is real, not imagined. Medicines, physiotherapy and other treatments help many people, and it often eases with time.
Can I sit comfortably after an external hemipelvectomy?
Sitting is uneven at first, because the sitting bone on that side has gone. A shaped cushion or a moulded seat helps. A physiotherapist and an occupational therapist will help you find positions for eating, working and travelling.
Will I walk after an internal hemipelvectomy?
Many people do, though often with a limp and a stick or crutches. How well depends on which part of the pelvis was removed. Losing the hip socket affects walking most. Losing only the front or the wing of the pelvis usually affects it less.
Can an internal operation become an external one later?
Sometimes. If the tumour comes back, or if a deep infection around an implant cannot be controlled, an external operation may be advised later. This is not common, but it is worth asking about before the first operation.
Will I still be able to use the toilet normally?
Usually yes, because the nerves to the bladder and bowel are mostly kept in a hemipelvectomy. If the sacrum is also involved, some changes are possible. A western toilet or a raised seat makes things easier in the early months.
Can we get a second opinion before deciding?
Yes, and it is reasonable for a decision this large. Take all scans on a disc or pen drive, the biopsy report, and the slides or blocks if possible. A good team will not mind, and will share the records you need.
Is hemipelvectomy covered by Aarogyasri or insurance?
Cancer surgery is often covered by Aarogyasri, CGHS, ECHS, EHS and cashless insurance. Implants, artificial legs and long rehabilitation may not be fully included. Ask for a written estimate and check each item against your cover before the date is fixed.
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Sources
- National Cancer Institute — Bone Cancer
- American Cancer Society — Bone Cancer
- NHS — Amputation
- Cancer Research UK — Bone cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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