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Spuehler D, Kuster L, Ullrich O, Grob K. Femoral nerve palsy following Girdlestone resection arthroplasty: An observational cadaveric study. World J Orthop 2024; 15:1175-1182. [DOI: 10.5312/wjo.v15.i12.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 11/12/2024] [Accepted: 12/05/2024] [Indexed: 12/17/2024] Open
Abstract
BACKGROUND When patients with a failed hip arthroplasty are unsuitable for reimplantation, Girdlestone resection arthroplasty (GRA) is a viable treatment option. We report on a patient who was treated with a GRA due to a periprosthetic infection. We discovered partial paralysis of the quadriceps muscle in this patient. We investigated the femoral nerve anatomy, particularly the nerve entry points, to better understand this phenomenon.
AIM To reveal the femoral nerve anatomy with respect to severe proximal migration after GRA.
METHODS Eight cadaveric hemipelves were investigated. The branches of the femoral nerve were dissected and traced distally. The GRA was performed by the direct anterior approach. Axial stress to the lower extremity was applied, and the relative movement of the femur was recorded. The femoral nerve and its entry points were assessed.
RESULTS GRA led to a 3.8 cm shift of the femur in vertical direction, a 1.8 cm shift in the dorsal direction, and a 2.3 cm shift in the lateral direction. A 36.5° external shift was observed. This caused stress to the lateral division of the femoral nerve. We observed migration of the femoral nerve entry point at the following locations: (1) Vastus medialis (5.3 mm); (2) The medial part of the vastus intermedius (5.4 mm); (3) The lateral part of the vastus intermedius (16.3 mm); (4) Rectus femoris (23.1 mm); (5) Tensor vastus intermedius (30.8 mm); and (6) Vastus lateralis (28.8 mm).
CONCLUSION Migration of the femur after GRA altered the anatomy of the femoral nerve. Stress occurred at the lateral nerve division leading to poor functional results.
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Affiliation(s)
- Dominik Spuehler
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Sankt Gallen, Sankt Gallen 9007, Switzerland
| | - Lukas Kuster
- Department of Orthopaedics Surgery, Sir Charles Gairdner Hospital, Perth 6009, Western Australia, Australia
| | - Oliver Ullrich
- Institute of Anatomy, University of Zurich, Zurich 8057, Switzerland
| | - Karl Grob
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Sankt Gallen, Sankt Gallen 9007, Switzerland
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Nester MD, Tabbaa A, Simon P, Lyons ST, Palumbo BT, Bernasek TL. Hip Resection Arthroplasty as Definitive Treatment: Indications, Outcomes, and Complications in Paraplegic and Non-Paraplegic Patients. J Arthroplasty 2024:S0883-5403(24)01278-6. [PMID: 39617274 DOI: 10.1016/j.arth.2024.11.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 11/19/2024] [Accepted: 11/21/2024] [Indexed: 01/13/2025] Open
Abstract
BACKGROUND Hip resection arthroplasty (HRA) serves as a salvage treatment option for various conditions affecting paraplegic patients. In nonparaplegic individuals, it is often utilized to manage complex infections. There exists a paucity of studies comparing outcomes between paraplegic and nonparaplegic patients undergoing HRA as definitive treatment. This study aimed to analyze the demographics, indications, outcomes, and complications in these two patient groups. METHODS A retrospective analysis was conducted on 65 patients who underwent HRA, divided into paraplegic (n = 25) and nonparaplegic (n = 40) groups. Data encompassed demographics, preoperative indications, postoperative complications, and outcomes. RESULTS Paraplegic patients exhibited distinct characteristics compared to nonparaplegic counterparts, including younger age (P < 0.001), lower comorbidity scores (P = 0.013), fewer prior hip operations (P = 0.002), and a higher proportion of men (P < 0.001). Septic arthritis emerged as the primary indication for definitive HRA in both groups, constituting 64% of paraplegic and 42.5% of nonparaplegic cases. Nonparaplegic patients experienced a significant reduction in pain scores postoperatively (P < 0.001), with a notable improvement in mobility. Infection eradication rates were comparable between the two groups, with 82 and 92% success rates in paraplegic and nonparaplegic cases, respectively. However, paraplegic patients exhibited a higher reoperation rate (P = 0.041), while nonparaplegic individuals encountered increased major systemic complications (P = 0.052). Although the total complication rate was slightly higher in the nonparaplegic group (75 versus 56%), the difference was not statistically significant (P = 0.211). CONCLUSIONS An HRA was the definitive treatment that successfully treated infection in both groups. In the nonparaplegic group, it led to enhanced ambulatory capacity and decreased pain. Paraplegic patients experienced higher rates of reoperation, whereas nonparaplegic patients suffered from greater rates of major systemic complications. These findings provide valuable insights for clinicians considering HRA as a definitive treatment.
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Affiliation(s)
- Matthew D Nester
- University of South Florida, Morsani College of Medicine, Tampa, Florida; Department of Translational Research, Foundation for Orthopaedic Research and Education, Tampa, Florida
| | - Ameer Tabbaa
- Department of Translational Research, Foundation for Orthopaedic Research and Education, Tampa, Florida
| | - Peter Simon
- Department of Translational Research, Foundation for Orthopaedic Research and Education, Tampa, Florida
| | - Steven T Lyons
- Department of Orthopaedic Surgery, Tampa General Hospital, Tampa, Florida; Florida Orthopaedic Institute, Tampa, Florida
| | | | - Thomas L Bernasek
- Department of Orthopaedic Surgery, Tampa General Hospital, Tampa, Florida; Florida Orthopaedic Institute, Tampa, Florida
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Condell R, Low L, Kearns SR, Murphy CG. Girdlestone resection arthroplasty of the hip (GRA): a case series-outdated procedure or acceptable outcome? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1711-1715. [PMID: 38071685 DOI: 10.1007/s00590-023-03793-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/16/2023] [Indexed: 04/02/2024]
Abstract
Despite considerable legacy issues, Girdlestone's resection arthroplasty (GRA) remains a valuable tool in the armoury of the arthroplasty surgeon. When reserved for massive lysis in the context of extensive medical co-morbidities which preclude staged or significant surgical interventions, and/or the presence of pelvic discontinuity, GRA as a salvage procedure can have satisfactory outcomes. These outcomes include infection control, pain control and post-op function. We describe a case series of 13 cases of GRA and comment of the indications, peri, and post-operative outcomes.
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Affiliation(s)
| | - Lyndon Low
- University Hospital Galway, Galway, Ireland
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Koshire S, Jain S, Wankhade A. Proximal femur shaft fracture in a case of ipsilateral resection arthroplasty of a tuberculous hip - A rare case report. J Clin Orthop Trauma 2021; 24:101716. [PMID: 34926148 PMCID: PMC8646163 DOI: 10.1016/j.jcot.2021.101716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/16/2021] [Accepted: 11/20/2021] [Indexed: 10/19/2022] Open
Abstract
Femur shaft fracture is a common entity in orthopaedic practice, but how commonly does one encounter a subtrochanteric femur fracture in ipsilateral resection arthroplasty of a tuberculous hip after a decade of uneventful unassisted ambulation post resection procedure ? Till date only 2 patients have been reported worldwide with femur diaphyseal fracture with a history of ipsilateral resection arthroplasty all performed within a year of fracture occurrence. The intriguing factor of our case was the fact that post resection, patient was ambulatory for a decade and the fracture occurred at a subtrochanteric level. Thus we report a case of 35 year old male with subtrochanteric femur fracture due to minor trauma to right thigh, with a history of tuberculous arthritis of right hip for which surgical management in the form of resection arthroplasty was done 10 years back. After a thoughtful decision making and plan formulation we managed the patient with surface fixation with a pre contoured GT (greater trochanter) configuration plate after taking into consideration status of intact GT, osteoporosis, pseudoarthrosis level and post operative ambulation and rehabilitation.
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Arthroscopic resection arthroplasty for septic hip with osteonecrosis of the femoral head in patients with multiple comorbidities: A report of two cases. J Orthop Sci 2021; 26:186-189. [PMID: 30001918 DOI: 10.1016/j.jos.2018.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 04/10/2018] [Accepted: 05/16/2018] [Indexed: 11/21/2022]
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Sawadogo M, Kafando H, Ouedraogo S, Korsaga AS, Ouedraogo S, Tinto S, Ouedraogo AJI, Tall M, DA SC. Is Head and Neck Resection of the Femur (Girdlestone's Procedure) Still Relevant? Indications and Results About 24 Cases. Open Orthop J 2018. [PMID: 29541272 PMCID: PMC5842383 DOI: 10.2174/1874325001812010069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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.
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Affiliation(s)
- Mamoudou Sawadogo
- Yalgado Ouedraogo University Hospital 03 BP 7022 Ouagadougou 03 Burkina Faso
| | - Hamado Kafando
- Yalgado Ouedraogo University Hospital 03 BP 7022 Ouagadougou 03 Burkina Faso
| | - Salam Ouedraogo
- Ouahigouya Regional University Hospital Center BP 36, Ouahigouya Burkina Faso
| | | | | | - Sayouba Tinto
- Yalgado Ouedraogo University Hospital 03 BP 7022 Ouagadougou 03 Burkina Faso
| | | | - Mohamed Tall
- Yalgado Ouedraogo University Hospital 03 BP 7022 Ouagadougou 03 Burkina Faso
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7
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Mahmoud SSS, Sukeik M, Alazzawi S, Shaath M, Sabri O. Salvage Procedures for Management of Prosthetic Joint Infection After Hip and Knee Replacements. Open Orthop J 2016; 10:600-614. [PMID: 28144373 PMCID: PMC5226968 DOI: 10.2174/1874325001610010600] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/24/2016] [Accepted: 07/15/2016] [Indexed: 02/07/2023] Open
Abstract
Background: The increasing load placed by joint replacement surgery on health care systems makes infection, even with the lowest rates, a serious concern that needs to be thoroughly studied and addressed using all possible measures. Methods: A comprehensive review of the current literature on salvage procedures for recurrent PJIs using PubMed, EMBASE and CINAHL has been conducted. Results: Prolonged suppressive antibiotic therapy (PSAT), resection arthroplasty and arthrodesis were the most common procedures performed. Suppressive antibiotic therapy is based on the use of well tolerated long term antibiotics in controlling sensitive organisms. Resection arthroplasty which should be reserved as a last resort provided more predictable outcomes in the hip whereas arthrodesis was associated with better outcomes in the knee. Various methods for arthrodesis including internal and external fixation have been described. Conclusion: Despite good union and infection control rates, all methods were associated with complications occasionally requiring further surgical interventions.
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Affiliation(s)
- Samer S S Mahmoud
- Department of Trauma and Orthopaedics, South Tees NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3 BW, United Kingdom
| | - Mohamed Sukeik
- Department of Trauma and Orthopaedics, The Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom
| | - Sulaiman Alazzawi
- Department of Trauma and Orthopaedics, The Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom
| | - Mohammed Shaath
- Department of Trauma and Orthopaedics, North Manchester General Hospital, Delaunay's Road, Crumpsall, M8 5RB, United Kingdom
| | - Omar Sabri
- Department of Trauma and Orthopaedics, St Georges NHS Foundation Trust, Tooting, London, SW17 0QT, United Kingdom
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8
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Kliushin NM, Ababkov YV, Ermakov AM, Malkova TA. Modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov external fixator as a salvage method in the management of severely infected total hip replacement. Indian J Orthop 2016; 50:16-24. [PMID: 26955173 PMCID: PMC4759869 DOI: 10.4103/0019-5413.173513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Resection arthroplasty or hip arthrodesis after total hip replacement (THR) can be used to salvage the limb in case with deep infection and severe bone loss. The Ilizarov fixator provides stability, axial correction, weight-bearing and good fusion rates. MATERIALS AND METHODS We retrospectively assessed the outcomes of 37 patients with severe periprosthetic infection after THR treated between 1999 and 2011. The treatment included implant removal, debridement and a modified Girdestone arthroplasty (29 cases) or hip arthrodesis (seven cases) using the Ilizarov fixator. The Ilizarov fixation continued from 45 to 50 days in the modified arthroplasty group and 90 days in the arthrodesis group. One case was treated using the conventional resection arthroplasty bilaterally. RESULTS Eighteen months after treatment, infection control was seen in 97.3% cases. Six hips were fused as one patient died in this group. Limb length discrepancy (LLD) averaged 5.5 cm. The Harris hip score ranged from 35 to 92 points. Hip joint motion ranged from 10° to 30° in the modified arthroplasty group. All subjects could walk independently or using support aids. No subluxation or LLD progression was observed. CONCLUSION The modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov apparatus results in sufficient ability for ambulation and good infection control in cases of failed THR associated with severe infection.
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Affiliation(s)
- Nikolai M Kliushin
- Bone Infection Clinic, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan 640014, Russian Federation, Russia
| | - Yuri V Ababkov
- Department of Bone Infection, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan 640014, Russian Federation, Russia
| | - Artem M Ermakov
- Department of Bone Infection, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan 640014, Russian Federation, Russia
| | - Tatiana A Malkova
- Department of Scientific Medical Information, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan 640014, Russian Federation, Russia
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9
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Rubin LE, Murgo KT, Ritterman SA, McClure PK. Hip Resection Arthroplasty. JBJS Rev 2014; 2:01874474-201405000-00003. [PMID: 27500608 DOI: 10.2106/jbjs.rvw.m.00060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Lee E Rubin
- University Orthopedics, Inc., Medical Office Center, 2 Dudley Street, Suite 200, Providence, RI 02905
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10
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Abstract
Girdlestone is one of the options for treating an infected hip arthroplasty (along with isolated antibiotics, debridement, and one or two-stage exchange). The choice must be based on a list of previous considerations. RESULTS OF GIRDLESTONE: Major differences among different series are reported in literature: from 13% to 83% of patients are satisfied with the result. Healing of infection is attained in 80% to 100% of patients, but figures are worse in special subsets (rheumatoid arthritis, enterococcal and methicillin-resistant infections, or when cement is retained). Pain is reported as severe in 16% to 33% of patients, moderate in 24% to 53% and mild in 76%, while only some authors refer to "satisfactory pain relief". Up to 45% of geriatric patients are unable to walk and only 29% walk independently. The literature reports Harris Hip scores from 25 to 64. INDICATIONS FOR GIRDLESTONE: Absolute indications: non-ambulatory patients because of other problems or diseases, and impossible reimplantation (2nd-stage surgery) (unacceptable anaesthetic or surgical risk, technical difficulties, patient rejection). RELATIVE INDICATIONS: Dementia (risk of dislocation vs. severely reduced walking ability), immunocompromise (up to what degree of immune impairment do we accept to take the risk?), intravenous drug abuse (how can you prove it?).
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11
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Mohanty SS, Agashe MV, Sheth BA, Dash KK. Outcome of total hip arthroplasty as a salvage procedure for failed infected internal fixation of hip fractures. Indian J Orthop 2013; 47:87-92. [PMID: 23533069 PMCID: PMC3601242 DOI: 10.4103/0019-5413.106921] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Failed infected internal fixation produces significant pain and functional disability. In infected internal fixation of hip fractures with partial or complete head destruction, total hip arthroplasty (THA) can be technically challenging; however, it restores hip biomechanics. The present study is to evaluate the results and assess the complications of THA following failed infected internal fixation of these fractures. MATERIALS AND METHODS A retrospective review of prospectively collected data in a tertiary healthcare center was performed of 20 consecutive patients of THA following failed infected internal fixation operated between September 2001 and November 2007. There were 11 dynamic hip screw failures for intertrochanteric fractures, 6 failed osteotomies following transcervical fractures, and 3 failed screw fixations for transcervical fractures. RESULTS The average age of the patients was 48.5 years (range 28-70 years) and the average followup period was 6.5 years (range 3.5-10.5 years). An indigenously designed cement spacer was used in a majority of patients (n = 15). The custom-made antibiotic impregnated cement spacer was prepared on-table, with the help of a K-nail bent at 130°, long stem Austin Moore's prosthesis (n=1), Charnley's prosthesis (n=1), or bent Rush nail (n=1). The antibiotic mixed cement was coated over the hardware in its doughy phase and appropriately shaped using an asepto syringe or an indigenously prepared spacer template. Nineteen of the 20 patients underwent two-stage revision surgeries. The average Harris hip score improved from 35.3 preoperatively to 82.85 postoperatively at the last followup. A significant difference was found (P < 0.0001). None of the patients had recurrence of infection. CONCLUSIONS The results were comparable to primary arthroplasty in femoral neck fractures. Thus, THA is a useful salvage procedure for failed infected internal fixation of hip fractures.
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Affiliation(s)
- Shubhranshu S Mohanty
- Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India,Address for correspondence: Prof. Shubhranshu S. Mohanty, Professor (Addl.), Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, 6th Floor, MS Buliding, Acharya Donde Marg, Parel, Mumbai 400 012, India. E-mail:
| | - Mandar V Agashe
- Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India
| | - Binoti A Sheth
- Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India
| | - Kumar K Dash
- Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India
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Dunn J, Scully WF, Crawford DA, Manoso MW. Ipsilateral diaphyseal femur fracture after resection arthroplasty. J Arthroplasty 2012; 27:1580.e17-9. [PMID: 22386608 DOI: 10.1016/j.arth.2012.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 01/20/2012] [Indexed: 02/01/2023] Open
Abstract
Resection arthroplasty of the hip is most commonly used for recalcitrant infections in the setting of prior hemiarthroplasty and total hip arthroplasty. Reported complications of this procedure include shortening of the extremity and ambulation difficulties requiring assistive devices. We report a case of an unusual finding of an ipsilateral femoral shaft fracture after a ground level fall 4 months after a resection arthroplasty for a septic hip. A closed reduction with internal fixation using an intramedullary nail was performed, and 3 months postoperatively, the patient was ambulating with device assistance.
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Affiliation(s)
- John Dunn
- William Beaumont Army Medical Center and Texas Tech University Health Sciences Center, El Paso, TX, USA
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13
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Oheim R, Gille J, Schoop R, Mägerlein S, Grimme CH, Jürgens C, Gerlach UJ. Surgical therapy of hip-joint empyema. Is the Girdlestone arthroplasty still up to date? INTERNATIONAL ORTHOPAEDICS 2011; 36:927-33. [PMID: 21986890 DOI: 10.1007/s00264-011-1351-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 08/22/2011] [Indexed: 12/26/2022]
Abstract
PURPOSE Hip-joint empyema is a severe local infection that can cause general illness and, in the worst-case scenario, death by septic complications. For severe hip-joint infections, the Girdlestone arthroplasty has been an established treatment option for many decades. We describe functional midterm results after treatment of haematological and postoperative hip-joint infections. METHODS From 2000 to 2010, 24 patients underwent surgical treatment for 27 hip-joint empyemas. The surgical procedures included radical debridement, implantation of local antibiotic beads and soft tissue management. Besides clinical, laboratory and imaging parameters, we analysed the Harris hip score (HHS). RESULTS Twenty-three patients (26 hips) were followed up after a mean of 30 (3.1-126.8) months. The study group consists of 12 men and 11 women, with an average height of 1.71 m, weight of 84.7 kg and body mass index (BMI) of 28.6 kg/m(2). Hip-joint empyema was due to haematological septic spread in eight patients, surgery related in 12 hips and other causes in six cases. One patient died due to septic complications during the hospital stay. Intraoperative bacterial culture was positive in 50%, with Staphylococcus aureus as the most common organism (n = 11). Average hospital stay was 35 days. HHS significantly improved from 18.2 preoperatively to 47.8 at follow-up. Functional results were mainly poor, but pain relief increased significantly. The infection control rate was 96% with four (15%) complications. CONCLUSION Resection arthroplasty by Girdlestone is able to control infection in most cases with an acceptable complication rate but poor functional results. In conclusion, the Girdlestone arthroplasty still is an essential surgical strategy for treating hip-joint empyema in cases in which functional outcome is of lesser priority.
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Affiliation(s)
- Ralf Oheim
- BG Trauma Hospital Hamburg, Septic Bone and Joint Surgery, Bergedorfer Straße 10, 21033, Hamburg, Germany.
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14
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Basu I, Howes M, Jowett C, Levack B. Girdlestones excision arthroplasty: current update. Int J Surg 2011; 9:310-3. [PMID: 21315188 DOI: 10.1016/j.ijsu.2011.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 11/24/2010] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
Abstract
Girdlestones procedure has become a salvage operation reserved for patients with significant co-morbidities. Recent literature addresses this infrequently used intervention inadequately. This observational study aims to update current literature and review the modern role of this intervention in orthopaedic practice. Twenty-four records were obtained from which patient demographics, indications and co-morbidities were investigated. Seventeen patients completed an abridged Harris Hip Scoring questionnaire and commented on satisfaction. The average age was 78 years and patients had multiple co-morbidities. Dementia was the most frequent condition but several patients suffered from cardiovascular and respiratory disease. The most common operative indication was persistent prosthetic infection with Staphylococcus aureus, the most common pathogen. Overall mortality was 41% but all surviving patients had complete resolution of infection and 65% had adequate pain control. No patients mobilised without aids although 29% of patients were able to manage stairs and 29% were able to mobilise outdoors. Only 29% were unsatisfied with the outcome. This study demonstrates that Girdlestones candidates are an ageing high-risk group and shows that the Girdlestones procedure can, in select cases, provide good functional outcomes. However such intervention comes at the expense of high mortality and should therefore only be used as a last resort.
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Affiliation(s)
- I Basu
- Orthopaedic Department, Queens Hospital, Rom Valley Way, Romford RM7 0AG, United Kingdom.
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15
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Lei P, Zhao M, Hui LF, Xi WM. Bone Morphogenetic Protein-2 and Hyaluronic Acid on Hydroxyapatite-coated Porous Titanium to Repair the Defect of Rabbit’s Distal Femu. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/978-3-540-92841-6_417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Manjón-Cabeza Subirat JM, Moreno Palacios JA, Mozo Muriel AP, Cátedra Vallés E, Sancho Loras R, Ubeda Tikkanen A. [Functional outcomes after resection of hip arthroplasty (Girdlestone technique)]. Rev Esp Geriatr Gerontol 2008; 43:13-8. [PMID: 18684383 DOI: 10.1016/s0211-139x(08)71145-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION the complications of hip arthroplasty in elderly patients can lead to resection of the prosthesis and cement, also known as the Girdlestone technique. This kind of surgery causes serious dysmetria and alters gait dynamics, thus affecting the patient's functional ability. The aim of this study was to describe the functional outcome, 1 year after surgery, in a group of patients that underwent surgery with this technique. MATERIAL AND METHODS we performed a descriptive study of 48 patients aged more than 65 years old who underwent surgery with the Girdlestone technique from 1999 to 2005. Twenty-one patients completed the study. Functional outcome and pain were measured with the Harris scale, and gait with the Functional Ambulatory Classification (FAC) scale 1 year after surgery. RESULTS the mean age was 79.71 years. The most frequent causes of exeresis were periprosthetic infection in 42% and recurrent hip dislocation in 36%. Of the 21 patients assessed 1 year after the intervention, 42.8% were unable to walk and needed a wheelchair and only 28.5% were able to walk with the aid of one or two crutches. Pain was moderate in 23.8% of the patients and was mild in the remainder. The mean score on the Harris scale was 51 out of 100 points. CONCLUSIONS failure of hip arthroplasty requiring Girdlestone resection is very damaging to functional outcome in elderly patients.
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Huang YH, Polimeni G, Qahash M, Wikesjö UME. Bone morphogenetic proteins and osseointegration: current knowledge – future possibilities. Periodontol 2000 2008; 47:206-23. [DOI: 10.1111/j.1600-0757.2007.00240.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hall J, Sorensen RG, Wozney JM, Wikesjö UME. Bone formation at rhBMP-2-coated titanium implants in the rat ectopic model. J Clin Periodontol 2007; 34:444-51. [PMID: 17448048 DOI: 10.1111/j.1600-051x.2007.01064.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The objective of this study was to evaluate local bone formation at titanium porous oxide (TPO) implant surfaces adsorbed with recombinant human bone morphogenetic protein-2 (rhBMP-2). METHODS In vitro studies were used to estimate the kinetics of I125-labeled rhBMP-2 released from TPO surfaces with narrow (N) or open (O) pores. Machined/turned titanium (MT) surfaces served as control. The rat ectopic model was used to assess local bone formation. Briefly, TPO-N, TPO-O, and MT disc implants adsorbed with 5, 10, or 20 microg rhBMP-2, respectively, were implanted subcutaneously into the ventral thoracic region in 5-week-old male Long Evans rats. The animals were euthanized at day 14 postsurgery when implants with surrounding tissues were removed, radiographed, and gross observations recorded. The specimens were processed for histologic evaluation using conventional cut-and-grind techniques. TPO implants without rhBMP-2 included in a preliminary evaluation revealed no evidence of bone formation, tissue encapsulation, or vascularity, thus such controls were not further used. RESULTS TPO and MT implant surfaces adsorbed with 5 microg rhBMP-2 retained 2.3-5.4% rhBMP-2 following immersion and rinse in buffer, and 1.1-2.2% rhBMP-2 following repeated immersions and rinses over 27 days. TPO implants retained the most rhBMP-2 and MT implants retained the least. Explants revealed increased hard tissue formation, tissue encapsulation, and vascularity at TPO compared with MT implants. Radiographic observations were consistent with the explant observations. The histologic analysis showed greater amounts of bone formation, osteoblastic cells, osteoid, marrow, tissue encapsulation, vascularity, and bone voids for implants adsorbed with 10 and 20 microg rhBMP-2, and for TPO implants at the 5-microg rhBMP-2 dose. The histometric analysis revealed significantly greater bone formation at TPO-O than at MT implants at the 5-microg rhBMP-2 dose. All surfaces showed significant bone formation at the 10- and 20-microg dose. CONCLUSIONS rhBMP-2 adsorbed onto TPO implant surfaces executes an osteoinductive effect including bone contacting the implant surface. This effect is surface- and dose-dependent; the TPO-O surface yielding the most bone at the low discriminating rhBMP-2 dose.
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Affiliation(s)
- Jan Hall
- Research & Development, Nobel Biocare AB, Göteborg, Sweden
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Kutscha-Lissberg F, Hebler U, Esenwein SA, Muhr G, Wick M. Fusion of the septic knee with external hybrid fixator. Knee Surg Sports Traumatol Arthrosc 2006; 14:968-74. [PMID: 16552552 DOI: 10.1007/s00167-006-0052-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2005] [Accepted: 08/08/2005] [Indexed: 11/29/2022]
Abstract
Arthrodesis is a well-recognized salvage procedure in patients with septic destruction of knee joints. It offers the opportunity for restoring weight bearing capability and significant pain relief as well as eradication of infection, but at the expense of joint motion. However, arthrodesis in order to joint sepsis may be difficult to achieve because of poor bone stock, persistent infection and soft tissue compromise. From 2000 to June 2004, in 70 consecutive patients arthrodesis of the knee was indicated. Nineteen patients were considered to have external hybrid fixator (EHF) and were therefore included to the prospective study protocol. Forty-three stabilisations of destructed knee joints were done by a modular titanium rod. In these cases bony fusion was very unlikely to be achieved because of devastating defects due to infected total knee arthroplasties. Eight patients were treated by compression nailing. In these situations EHF was not indicated. In three patients minor complication occurred. In two out of 17 patients fusion failed because of primary underestimated bony defects (11.8%). The use of EHF for arthrodeses after septic destruction of knee joints can be recommended according to our results. However, EHF will not be successful or applicable in each case. Therefore, physicians and institutions that offer this special method should have not only experiences with EHF but also with arthrodeses and alternative procedures.
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Affiliation(s)
- F Kutscha-Lissberg
- University Hospital for Surgery, Ruhr-University Bochum, Chirurgische Klinik, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
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Sharma H, Dreghorn C, Gardner E. Girdlestone resection arthroplasty of the hip: Current perspectives. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.cuor.2005.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Anagnostakos K, Kelm J, Regitz T, Schmitt E, Jung W. In vitro evaluation of antibiotic release from and bacteria growth inhibition by antibiotic-loaded acrylic bone cement spacers. J Biomed Mater Res B Appl Biomater 2005; 72:373-8. [PMID: 15578650 DOI: 10.1002/jbm.b.30171] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The antibiotic release from and the bacteria growth inhibition by antibiotic-loaded acrylic bone cement hip spacers were studied. The cement used was Palacos R, and it was loaded with either one antibiotic powder (gentamicin, vancomycin, teicoplanin, or synercid) [monoantibiotic case] or two antibiotic powders (gentamicin + vancomycin or gentamicin + teicoplanin) [biantibiotic case] and then tested against Staphylococcus epidermidis, Staphylococcus aureus, Enterococcus faecalis, and methicillin-resistant Staphylococcus aureus (MRSA). Antibiotic elution and bacteria growth were measured every 24 h simultaneously by fluorescence polarization immunoassay and photometrically, respectively. The gentamicin + vancomycin combination achieved the longest growth inhibition on S. epidermidis and MRSA (mean of 20 and 14 days, respectively). Gentamicin + teicoplanin-loaded spacers were capable of inhibiting growth on E. faecalis and S. aureus for the longest period (11 and 16 days, respectively). The highest concentrations of gentamicin and vancomycin could be assayed during the first 4 days. Teicoplanin concentrations could be detected only during the first 72 h, synercid was not detected at all, possibly because of the limitation of the detection technique used. A greater percentage of the gentamicin was released than of the vancomycin. The aminoglycosid-glycopeptid combination showed a synergistic effect on the release of gentamicin, but not on vancomycin or teicoplanin. Biantibiotic-impregnated hip spacers proved to be superior to monoantibiotic ones. Because of important differences between the conditions used for the present tests and the in vivo environment, any recommendation with regard to the use of monoantibiotic- and biantibiotic-loaded acrylic bone cement spacers must await the results of further investigations.
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Sharma H, De Leeuw J, Rowley DI. Girdlestone resection arthroplasty following failed surgical procedures. INTERNATIONAL ORTHOPAEDICS 2005; 29:92-5. [PMID: 15703933 PMCID: PMC3474513 DOI: 10.1007/s00264-004-0633-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2004] [Accepted: 12/17/2004] [Indexed: 11/30/2022]
Abstract
We retrospectively reviewed 43 patients who had undergone Girdlestone resection arthroplasty of the hip after failed total hip replacement or failed operations for hip trauma between 1990 and 2002. The indications were peri-prosthetic infection, aseptic loosening, recurrent dislocation and failed internal fixation for femoral neck fractures. Twenty-five patients died with an overall mortality of 58%. Out of 18 survivors, four patients had a prosthesis re-implanted and were excluded from the study. In 14 surviving patients followed-up for a mean of 44.5 months, the average age was 76 years. Adequate pain relief was achieved in 12 patients and infection was controlled in all. They all needed walking aids. The overall patient satisfaction was 10/14. We observed that patients who had had resection arthroplasty following failed operations for hip trauma had a higher mortality than those for failed total hip arthroplasty. Girdlestone arthroplasty is still a viable option to salvage irretrievably failed hips presenting technical difficulties in medically compromised patients. Limb shortening and the inevitable need for a walking aid should be clearly explained to patients during the consenting process in order to avoid unrealistic expectations.
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Affiliation(s)
- H Sharma
- Department of Trauma and Orthopaedics, Victoria Infirmary, Glasgow, Scotland, G42 9TT, UK.
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