Girdlestone Arthroplasty Research Articles

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

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.

Medical and Surgical Treatment of the Septic Hip with One-stage Revision Arthroplasty

Sepsis of the hip, particularly associated with total hip arthroplasty, can be treated successfully by an aggressive antimicrobial and surgical approach to accomplish a one-stage revision. Although this is a very acceptable alternative to Girdlestone arthroplasty, 13% (6 hips) of the septic total hip revisions failed. The possibility of hematogenous seeding of the total hip should be recognized by all health care professionals. Aggressive treatment of infections or potential infections is mandatory.

Girdlestone Arthroplasty for Infected Total Hip Arthroplasty

Results of a previous study of 21 patients who underwent conversion of infected total hip arthroplasties to Girdlestone resection arthroplasties suggested that Girdlestone resection arthroplasty provides a functionally poor salvage technique and is often painful. The present study was undertaken to assess further the salvage value of Girdlestone arthroplasties for the treatment of infected total hips. Fourteen additional cases were reviewed, summarizing the clinical experience of the past three years. These more recent data support the conclusion that resection arthroplasty provides a poor functional result when used as a salvage procedure following removal of infected total hip components. Of the 14 patients reviewed, only one obtained an acceptable functional result. The initial 21 patients studied were re-reviewed to obtain further follow-up data. The functional results obtained were essentially unchanged and are comparable with those from the series of 14 patients reviewed in this study. In some cases of infected total hip arthroplasty, resection arthroplasty is the best method of treatment available, but the results are often far from ideal. Direct or indirect prothesis exchange is an alternative in some cases. Total hip arthroplasty should not be recommended for the young patient who has one or two joint diseases and no limiting systemic factors, with the expectation that when the total hip fails, it can be converted to a resection arthroplasty and the patient improved as compared with the pre-total hip status. It may be wiser to utilize another procedure, e.g., fusion, resection arthroplasty, or osteotomy, primarily, and then revise to a total hip, if necessary, when the patient is older.

The direct lateral approach to the hip.

A direct lateral approach to the hip is described which allows adequate access for orientation of the implant, for the insertion ofthe cement and for the correction ofdiscrepancy in leg length. An anatomical observation was made that the gluteus medius muscle is inserted into the greater trochanter by a tendon and that the axis of the shaft of the femur lies anterior to the main bulk of the muscle which was left

The McKee-Farrar Total Hip Replacement

The first 403 McKee-Farrar total hip replacement arthroplasties performed in five general hospitals in Vancouver by twenty-three different surgeons have been reviewed after an average follow-up of 1.4 years (range three months to four years). Thirty-five were excluded for various reasons leaving 368 (242 unilateral and sixty-three bilateral) available for analysis. Total hip replacement was performed for idiopathic osteoarthritis in 241 hips, for post-traumatic arthritis in forty-two, for rheumatoid arthritis in thirty-nine, for congenital dysplasia in six, and for a variety of conditions in the remaining hips. Previous surgical procedures had been performed on seventy-four (20 per cent) hips in sixty-nine patients. The results of total hip replacement were evaluated in terms of relief of pain, range of motion, and ability to walk. For pain relief the results were: improved, 85 per cent; no change, 10 per cent; and worse, 5 per cent. For range of motion the results were: improved, 76 per cent; no change, 20 per cent; and worse, 4 per cent. For ability to walk the results were: improved, 69 per cent; no change, 25 per cent; and worse, 6 per cent. In this series 184 complications occurred after 115 replacement procedures. These complications included five deaths, thirty-two instances of periarticular ossification, thirty postoperative infections (eleven early and nineteen late), twenty-four instances of loosening of the prosthesis (nine aseptic and fifteen septic), twenty-seven cases of thromboembolic disease, ten non-unions of the greater trochanter, twenty-one other systemic complications, and other less frequent local complications such as dislocation, recurrent subluxation, and so forth. The highest incidence of complications was in the patients who had had previous surgical procedures on the hip in which the total hip replacement was performed. The complications were analyzed in detail. There were sixty-three total hip replacements that were rated failures (unsatisfactory to the patient, surgeon, or both). These failures occurred in fifty-seven hips, some of which had more than one total replacement that failed. The failures were classified as mechanical in thirty-six, biological in seventeen, and technical in ten. The causes of failure in each of these categories were reviewed. Sixty-four salvage procedures were performed on forty-seven hips. These procedures included relocation of a dislocated prosthesis in eight hips, drainage of a hematoma or infection in sixteen, revision and reinsertion of the prosthesis in fourteen, a Girdlestone arthroplasty in seventeen, and a variety of other procedures perfomed two times or less. Since completion of this study late infection and loosening have developed in some of the hips previously rated as having good results. Based on the findings in this study, it is concluded that the over-all results of total hip replacement are very impressive but that this procedure should not be done by the occasional hip surgeon but by those who have a thorough knowledge of surgery of the hip joint and who are equipped to deal with the complications.