A six-year follow-up of infected total hip replacements managed by Girdlestone's arthroplasty

Abstract

Thirty-three Girdlestone's arthroplasties used to salvage infected total hip replacements were followed for a mean of 6.2 years to assess the efficacy of this procedure. Subjective and objective assessment was obtained at the time of review. Gram-negative organisms, retained cement, bony sequestra and secondary healing were common features of the five patients (15%) whose wounds discharged for more than four weeks after operation. Girdlestone's arthroplasty provided satisfactory pain relief in 91% of patients, and control of infection in 97%. Although leg-length discrepancy (mean 4 cm) and a Trendelenburg gait made walking difficult and tiring , 42% were satisfied with their functional ability; 85% needed walking aids, and 3 patients could not walk at all and were confined to bed or a chair. Overall, 79% were satisfied. Objectively, the mean Harris hip rating was 60; however, if patients with multiple joint problems were excluded, this score increased to 77. Girdlestone's arthroplasty seems a reasonable salvage procedure in the management of an infected total hip replacement and the results seem to improve with time.

Girdlestone resection arthroplasty following failed surgical procedures

“…Deep infection complicates between 1% and 2% of total hip replacements [2,4,6]. Clegg advocated complete removal of all the cement remnants in order to achieve eradication of infection [7], but we agree with the views of others that small amounts of retained cement do not seem to influence wound healing after resection arthroplasty [1,4,13].…”

“…Patients with severe loss of bone stock, risk of recurrent infection or poor general condition [2,4,9,11] may not be suited for further major interventions, especially one-or two-stage reimplantation after failed primary total hip replacement. In such cases, Girdlestone resection arthroplasty is considered to be an acceptable option.…”

Comparison of the results of the Girdlestone pseudarthrosis with reimplantation of a total hip replacement

“…Reimplantation of a prosthesis into a long standing pseudarthrosis can be technically difficult and the patients should be carefully selected [3]. The indications are poor function and pain.…”

“…The pseudarthrosis remains a reasonable salvage operation for special problems [3], but reimplantation Fig. 3a-c.…”

A Case Report- Tuberculous Dislocation of Pediatric Hip Managed by Naseer Awais External Fixator

“…Traditionally, in the presence of osteomyelitis of the femur and dislocation, excision arthroplasty would have been the first choice in adults. Although the Girdle stone procedure [6,7] may reduce pain, the functional outcome is often poor. Studies of the conversion of a Girdle stone pseud arthrosis to an arthroplasty have shown improvements in the Harris hip score 8 personal satisfaction and activities of daily living, but only in the absence of infection [8][9][10].…”