Disclosures: Jeremy Roberts, MD: No financial relationships or conflicts of interest

Case Description: 13-year-old non-ambulatory female with estimated L1 myelomeningocele and chronic open sacral wound found to have chronic osteomyelitis of the right ilium, ischium, pubis, destruction of acetabulum, with prolonged hospitalization for conservative wound management. Our patient had chronic right pelvic osteomyelitis with multiple organisms including MDR enterobacter cloacae refractory to multiple rounds of antibiotics. She required right external hemipelvectomy to prevent lymphatic spread of infection. After routine treatment for amputation, she was transferred to an intensive rehabilitation center. In rehab, she received a new prosthesis and Reciprocal Gait Orthosis (RGO). She received a right hemipelvectomy prosthesis, and a unilateral left reciprocal gait orthosis (RGO).

Setting: Tertiary Care Pediatric Hospital

Patient: 13-year-old non-ambulatory female with estimated L1 myelomeningocele and chronic osteomyelitis s/p right external hemipelvectomy. Assessment/

Results: Through multidisciplinary rehabilitation, the patient developed the ability to stand and ambulate with a newly fabricated custom hemipelvectomy prosthesis, and the use of a contralateral reciprocal gait orthosis (RGO). This allowed her to use her preserved left hip strength to assist the right limb. Within three months, she was ambulating over 180 feet.

Discussion: Our patient’s course is unique because she gained the ability to walk so late in life after being a non-ambulator. Currently, there is no literature on powering a high prosthesis with a contralateral RGO to improve ambulation. Her use of RGO is significant given her level of weakness in the preserved hip, the energy consumption and challenge of using a hemipelvectomy prosthesis, and her prior non-ambulatory status. Of note, this was an off-label use of these devices.

Conclusion: Guidance from Physiatry for aggressive therapy, prosthesis fabrication and bracing management allowed for this non-ambulatory patient to reach a new level of independence in the setting of hemipelvectomy and amputation.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/novel-use-of-right-hemipelvectomy-prosthesis-and-unilateral-reciprocal-gait-orthosis-to-promote-ambulation-in-a-previous-non-ambulator-with-spina-bifida/