Clinical outcome following conversion of Girdlestone’s resection arthroplasty to total hip replacement

Abstract

A total of 31 patients, (20 women, 11 men; mean age 62.5 years old; 23 to 81), who underwent conversion of a Girdlestone resection-arthroplasty (RA) to a total hip replacement (THR) were compared with 93 patients, (60 women, 33 men; mean age 63.4 years old; 20 to 89), who had revision THR surgery for aseptic loosening in a retrospective matched case-control study. Age, gender and the extent of the pre-operative bone defect were similar in all patients. Mean follow-up was 9.3 years (5 to 18). Pre-operative function and range of movement were better in the control group (p = 0.01 and 0.003, respectively) and pre-operative leg length discrepancy (LLD) was greater in the RA group (p < 0.001). The post-operative clinical outcome was similar in both groups except for mean post-operative LLD, which was greater in the study group (p = 0.003). There was a significant interaction effect for LLD in the study group (p < 0.001). A two-way analysis of variance showed that clinical outcome depended on patient age (patients older than 70 years old had worse pre-operative pain, p = 0.017) or bone defect (patients with a large acetabular bone defect had higher LLD, p = 0.006, worse post-operative function p = 0.009 and range of movement, p = 0.005), irrespective of the group. Despite major acetabular and femoral bone defects requiring complex surgical reconstruction techniques, THR after RA shows a clinical outcome similar to those obtained in aseptic revision surgery for hips with similar sized bone defects.

Complications of Resection Arthroplasty in Two-Stage Revision for the Treatment of Periprosthetic Hip Joint Infection

“…Dislocations occurred in 7.5% of patients (6% in group 1, 9% in group 2) within the first four weeks after reconstruction, which is in line with previous reports demonstrating a dislocation rate of 3%-11% in patients treated with resection arthroplasty [22,23,25] and comparable to the dislocation rate with cement spacer, which was described to be 1%-8% [10,22,26]. The probability of periprosthetic fracture after reimplantation in our study was 3.2%, which was similar to the reported incidence of 3.2% with resection arthroplasty and 4.3% with spacer use [22].…”

“…The leg length discrepancy after conversion of resection arthroplasty into total hip arthroplasty occurs mainly due to soft tissue contracture and acetabular and femoral bone loss. Garcia-Rey et al [22] showed greater leg length discrepancy in patients with conversion after a mean of 39 months compared to patients, who had revision surgery for aseptic loosening. Charlton et al [23] evaluated complications associated with reimplantation after Girdlestone arthroplasty in 44 patients.…”

Salvage Procedures for Management of Prosthetic Joint Infection After Hip and Knee Replacements

“…[54] compared the outcomes of THR following a Girdlestone procedure to those of revision THR performed for aseptic loosening. They found that post-operative clinical outcomes were similar in both groups despite significantly worse limb length discrepancy (LLD) affecting the girdlestone group.…”

“…They found that post-operative clinical outcomes were similar in both groups despite significantly worse limb length discrepancy (LLD) affecting the girdlestone group. For both groups, older age (>70 years) and large acetabular bone defects were associated with higher LLD, worse post-operative function and range of movement [54]. Despite various reports confirming improved outcomes post conversion to a THR [55], the number of potential complications renders this procedure a challenge for both the surgeon and the patient.…”

Medical innovations to maintain the function in patients with chronic PJI for whom explantation is not desirable: a pathophysiology-, multidisciplinary-, and experience-based approach

“…However, prosthesis explantation is sometimes not feasible, especially for the knee location in elderly patients with multiple comorbidities for whom explantation could be associated with a dramatic loss of function, reduction of the bone stock, fracture, or peroperative death [ 2 , 4 – 6 ]. Indeed, explantation without reimplantation, also called resection arthroplasty, or Gilderstone procedure, is possible for the hip but not recommended for the knee, as the functional consequences are not acceptable, even if some authors reported exceptional favorable outcomes [ 7 – 10 ]. Moreover, reimplantation using silver-coated arthrodesis could be more complex as expected and transfemoral amputation is associated with a poor functional outcome [ 11 , 12 ].…”