Successful Rehabilitation of a Young Adult With Total Hip Arthroplasty a Decade After a Girdlestone Procedure: A Case Presentation

Abstract

This is a case report of a female who underwent a Girdlestone arthroplasty at age 10 and a total hip arthroplasty at age 21. Despite early post-operative rehabilitation, the patient experienced increasing pain, progressive gait deviations and functional limitations during the year following surgery. This course of care was initiated one year after surgery and focused on motor retraining to address pain and gait deviations. This case demonstrates that positive outcomes can be achieved after longstanding musculoskeletal dysfunction is corrected, but that prolonged rehabilitation may be necessary to produce changes in movement patterns at both the local (joint and muscle) and central (cortical) levels. Correction of both the structural problem and the learned movement patterns is necessary for a successful outcome.

Girdle Stone Procedure in bilateral Rheumatoid Hip: A Case Report

“…With reference to its functional end results, this measure may be a good alternative to more modern and sophisticated hip surgeries in the form of partial or total hip replacement under certain conditions 10 . Our study support the findings of this case report in GSP was considered appropriate to cope with the functional disabilities, pain and improved gait biomechanics 5 . In later years hip arthroplasty may be considered if the condition of the patient allows.…”

“…Girdle stone procedure (GSP) is a salvage procedure and its indications to perform it have significantly been modified over time 4 however it can be considered at young age to prevent functional limitations, avoid pain and improve quality of gait 5 . In a study conducted in Germany by F Hefti, it was suggested that in juvenile RA, if hip is involved GSP may be considered prior to hip arthroplasty 6 .…”

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

“… 4 With the advent of replacement arthroplasty, the Girdlestone arthroplasty is considered as a procedure performed as a last resort in cases of significant infection, poor bone stock or failed total hip arthroplasty due to decreased functional outcomes. 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.…”

Rehabilitation Phases, Precautions, and Mobility Goals Following Total Hip Arthroplasty

“…Altered kinematics persist even when controlling for pain, walking speed, and limitations in available joint motion. In patients with long-standing gait abnormalities, increased time and supervision may be required during gait retraining to optimize kinetics and kinematics of walking and facilitate motor relearning at the central (cortical) level [27].…”