Is Head and Neck Resection of the Femur (Girdlestone’s Procedure) Still Relevant? Indications and Results About 24 Cases

Abstract

Introduction:Head and neck resection of the femur was described by Girdlestone in 1928 in the treatment of coxalgia. Very invasive at the beginning, this intervention is much less so today, but the term of “Girdlestone’s operation” or “Girdlestone’s procedure” has remained in use. The reported results are controversial. In resource-limited countries, Girdlestone’s procedure is often indicated for lack of a better one. In this context, we report the results of a series of 24 patients operated in a regional hospital (Ouahigouya, Burkina Faso) with the aim of showing that this technique remains valid and can be benefit. Methods: This was a retrospective descriptive study of 24 patients who had benefited from the procedure for cervical fracture sequelae, failure of arthroplasty or osteosynthesis, or osteonecrosis. All were operated by posterolateral approach, under spinal anesthesia and followed for 5 years with evaluation of the anatomical and functional results using the rating of Postel and Merle d'Aubigné (PMA). Results: All patients had Trendelenburg lameness with a mean shortening of 3.5 cm. They were all autonomous with walking aids and the PMA score ranged from 16 to 14. Discussion: although the results obtained are not excellent, they are relatively good and have allowed all our patients to recover an acceptable autonomy, compatible with certain independence in everyday life. Conclusion:The Girdlestone’s procedure cannot be a first intention indication, but retains a place in the therapeutic arsenal of certain affections of the hip.

Functional outcomes of an adult with osteogenesis imperfecta after rehabilitation post bilateral Girdlestone procedure

“… 5 It has been documented in use for patients with neglected femoral neck fractures, failed osteosynthesis, failed hemiarthroplasty and painful aseptic osteonecrosis of the femoral head. 6 Incidence of the procedure is generally low, with only 43 procedures performed from 1990 to 2002 in two large hospitals in the UK, 7 with recent trends pointing that the conduct of the procedure today is even lower. There is also a noted lack of literature on the bilateral procedure and its outcomes, with only anecdotal evidence of three patients, who were eventually able to ambulate with gait aids.…”

Is there a role for the Girdlestone resection arthroplasty in modern orthopedic trauma surgery? Case series from a medically underserved region and literature review

“…In contrast, individual cases from orthopedically underserved areas showed acceptable to good results according to GRA in younger patients, with just a few or no preexisting conditions [15]. GRA achieved in this case series good functional results with postoperative absence of infection in severe gunshot fractures close to the hip in a medically underserved region.…”

“…Analogous results, but in atraumatic hip degeneration could be achieved by GRA in medically similar areas [15]. However, in comparison with the available literature, it must be noted that the functional and esthetic results of the GRA are inferior to prosthetic restoration [8].…”

A Devasting Course of an Iliopsoas Muscle Abscess Subsequently Leading to Septic Shock, Septic Hip Arthritis, and Extended Gluteal Soft Tissue Necroses in an Elderly Immunocompromised Patient with Multiple Carcinomas: A Case Report and Brief Review of Literature

“…Using this procedure, healing of bony infection without MRSA is attained in 80% to 100% of patients, and worsened when MRSA infection was initially present, hence, for those patients who have additionally immune deficiency and high anaesthetic and operative risks a secondary conversion to THA is not recommended [ 36 , 37 ]. After surgery, a rise of the patients shoes with a mean of 3,5 cm ranging from 3 cm to 6 cm is needed for their mobilization with a walking aid [ 38 ]. However, not all of the patients are satisfied with their GRA.…”