• Hip resection arthroplasty
• Prosthetic joint infection
• Treatment outcome

• Girdlestone procedure
• antibiotic beads
• forensic anthropology
• hip arthroplasty
• osteology
• scoliosis

• Humans
• Female
• Middle Aged
• Anti-Bacterial Agents
• Arthroplasty, Replacement, Hip/adverse effects
• Femur/pathology
• Femur/surgery
• Prosthesis-Related Infections
• Surgical Wound Infection

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.

To reveal the femoral nerve anatomy with respect to severe proximal migration after GRA.

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.

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).

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.

• Girdlestone resection arthroplasty
• Resection arthroplasty of the hip
• Failed hip replacement
• Femoral nerve palsy
• Anatomy of the femoral nerve
• Periprosthetic infection

• Humans
• Male
• Female
• Prosthesis-Related Infections/surgery
• Aged
• Arthroplasty, Replacement, Hip
• Reoperation
• Aged, 80 and over
• Hip Prosthesis
• Age Factors
• Retrospective Studies
• Risk Factors
• Middle Aged
• United States
• Replantation

• Girdlestone resection arthroplasty
• antibiotic spacer
• clinical outcomes
• injection drug use
• septic hip arthritis

• 5T32AR067708-10 NIAMS NIH HHS

• calf
• computed tomography
• femoral head ostectomy
• hip arthritis
• ultrasonography

• avascular necrosis
• girdle-stone
• orthopaedic
• sickle cell disease
• total hip replacement

• Escherichia coli
• ankylosis
• arthritis, infectious
• hip joint

• Knee
• excision arthroplasty
• limb salvage
• osteomyelitis
• periprosthetic infection
• resection arthroplasty
• revision

• Flap Reconstruction
• Girdlestone Arthroplasty
• Ischial Sore
• Pressure Sore
• Trochanteric Sore
• Vastus Intermedius
• Vastus Lateralis

• Humans
• Quadriceps Muscle/surgery
• Pressure Ulcer/surgery
• Pressure Ulcer/complications
• Myocutaneous Flap/surgery
• Plastic Surgery Procedures
• Paraplegia/complications
• Paraplegia/surgery
• Femur/surgery
• Pain

• Excision arthroplasty
• Girdlestone
• hip fracture
• neck of femur fracture
• resection arthroplasty

• Humans
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Hip/methods
• Hip Fractures/surgery
• Hip Fractures/complications
• Pain/complications
• Pain/surgery
• Arthritis, Infectious/surgery
• Comorbidity
• Retrospective Studies
• Reoperation

• diagnosis
• hip joint
• osteoradionecrosis
• pathology
• radiotherapy
• residential treatment

• Humans
• Osteoradionecrosis/diagnosis
• Osteoradionecrosis/etiology
• Osteoradionecrosis/therapy
• Femur Head
• Diagnosis, Differential
• Radiation, Ionizing
• Arthroplasty, Replacement, Hip

• girdlestone resection arthroplasty
• hip prosthetic joint infection
• hip resection arthroplasty
• patient-reported outcomes
• salvage procedure

• Complications
• Girdlestone
• Hip resection arthroplasty
• Indications
• Revision total hip arthroplasty
• Total hip arthroplasty

Eliminating recalcitrant prosthetic hip joint infections remains one of the greatest challenges in orthopedic surgery. In such cases, the salvage procedure of femoral head excision (the Girdlestone procedure) is often performed. There has been emerging surgical interest in filling the resulting acetabular dead space with a pedicled muscle flap, to enable antibiotic delivery. Both vastus lateralis (VL) and rectus femoris (RF) muscle flaps have been described for this purpose with good success. This study is the first anatomical investigation comparing VL and RF as candidates for interposition myoplasty following hip joint excision. Following standard surgical technique, the Girdlestone procedure and interposition myoplasty of both RF and VL were performed on 10 cadavers. The primary aim was to determine which muscle flap eliminated a greater volume of acetabular dead space. Secondary aims were to characterize the blood supply to RF and assess additional metrics indicative of the likelihood of flap success. The VL flap eliminated more dead space than RF. However, the use of the RF flap was feasible in all cases and has several benefits, including ease of harvest, mobility, and aesthetics. The location of the inferior vascular pedicle into RF was relatively consistent and the most effective predictor of flap success. Both VL and RF are effective in reducing acetabular dead space. While VL can fill a greater volume, the RF flap has technical advantages, related to the predictability of the blood supply.

• girdlestone procedure
• infection
• interposition myoplasty
• rectus femoris
• vastus lateralis

To compare the surgical outcomes of debridement, antibiotics, and single‐stage total hip replacement (DASR) vs two‐stage arthroplasty (two‐stage arthroplasty) for chronic destructive septic hip arthritis (SHA).

Cases of chronic destructive SHA treated by DASR or two‐stage arthroplasty in our department from January 2008 to October 2021 were retrospectively reviewed. Patient demographic information, perioperative inflammation markers, intraoperative blood loss, microbial culture, and metagenomic new generation sequencing results were recorded. The perioperative complications, hospital stay, hospitalization cost, infection recurrence rate, and Harris Hip Score (HHS) at the last follow‐up were compared between the two groups.

A total of 28 patients were included in the study, including 11 patients who received DASR and 17 patients who received two‐stage arthroplasty. There was no significant difference in demographic information, preoperative serum inflammatory markers, synovial fluid white blood cell count, or percentage of polymorphonuclear leukocytes between the two groups. The DASR group demonstrated significantly lower intraoperative blood loss [(368.2 ± 253.3) mL vs (638.2 ± 170.0) mL, p = 0.002], hospital stay [(22.6 ± 8.1) days vs (43.5 ± 13.2) days, p < 0.0001], and hospitalization expenses [(81,269 ± 11,496) RMB vs (137,524 ± 25,516) RMB, p < 0.0001] than the two‐stage arthroplasty group. In the DASR group, one patient had dislocation as a complication. There were no cases with recurrence of infection. In the two‐stage arthroplasty group, there was one case complicated with spacer fracture, one case with spacer dislocation, and one case with deep vein thrombosis of the lower limbs. There were no cases with recurrence of infection. There were no significant differences in the readmission rate, complication rate, or HHS at the last follow‐up between the two groups.

Both DASR and two‐stage arthroplasty achieved a satisfactory infection cure rate and functional recovery for chronic destructive SHA, and DASR demonstrated significantly lower intraoperative blood loss, hospital stay, and hospitalization costs than two‐stage arthroplasty. For appropriately indicated patients, if microbial data are available and a standardized debridement protocol is strictly followed, DASR can be a treatment option.

• Debridement
• Next generation sequencing
• Septic arthritis
• Total hip arthroplasty

• Hip arthroplasty
• Megaprosthesis
• Proximal femoral replacement
• Revision surgery

• Aseptic loosening
• Revision hip arthroplasty
• Total hip arthroplasty
• Young patients
• acetabular components
• arthroplasties
• cemented implants
• excision
• femoral components
• femoral defects
• impaction bone grafting
• primary total hip arthroplasties
• revision surgery

Resection arthroplasty of the hip was already performed for recent 100 years. This kind of surgery has been used for a wide variety of hip problems such as infection, degenerative osteoarthritis and prosthetic joint infection. Total hip replacement is remarkable procedure in order to relieve pain and restore hip function. We present this report to describe our experience in treating hip infection by used two stages of surgery.

A 61-years old male suffered left hip infection that leads severe destruction on his joint. He felt badly pain on his hip with significant disability associated it such as limping, restriction of movements, and shortening of the limb. The hip movements were painful and caused walking in antalgic gait. Radiologic examination at that time revealed gross destruction of femoral head as well as acetabulum, irregular and hazy joint margins with diminished joint space. Patient was diagnosed with chronic non-specific inflammation of the hip joint.

Two stages surgery were performed on this patient. Resection arthroplasty firstly performed in order to eradicate the infection completely and alleviate very bothersome pain for improvement of patient's quality of life. Two years later, after patient was ready for next stage mentally, cemented total hip replacement performed to achieve normal function of the hip. Five-years follow up functional outcome was performed. Patient was very satisfied with the result with Harris hip scores was 95.

Resection arthroplasty of the hip followed by a conversion to total hip replacement in hip infection case provide complete infection eradication, good functional outcome and satisfaction for the patient. Although the procedure was time-consuming it can be a choice if the eradication of infection still in a doubt.

• Case report
• Girdlestone
• Hip infections
• Total hip replacement

Hemiarthroplasty (HA) is the current standard of care for displaced femoral neck fractures (FNFs) in non-ambulators. Despite excellent outcomes, arthroplasty-specific risks remain, including dislocation, implant failure, periprosthetic fracture and infection, and fat embolization syndrome. To eliminate the possibility of these complications, should non-ambulatory patients with acute, native hip FNFs be treated with simple hip resection arthroplasty (HRA) instead of HA?

Retrospective case series.

Large, urban level-1 trauma center.

Five non-ambulatory patients (6 hips) with acute, native hip FNF underwent femoral head and neck resection. Also, the most recent 10 FNFs treated with HA were also identified for comparison purposes.

HRA was performed via a Smith-Peterson approach with an oscillating saw or osteotome to complete the fracture or perform a fresh neck cut.

Outcomes included postoperative vs preoperative VAS pain scores and narcotics usage, and return to baseline functional status (sit up in bed or a chair postoperatively). Procedure time for HRA was compared with the 10 most recent patients with FNF treated with HA.

HRA resulted in decreased postoperative vs preoperative VAS pain scores (7.7 vs 3.3, P = .002), and decreased operative times (59.2 minutes for HRA, 111.8 minutes for HA, P < .001). All HRA patients had immediate return of baseline function.

HRA offers shorter operative times when compared with HA, decreased postoperative VAS pain scores, and immediate return to functional baseline status without possibility of arthroplasty-specific complications. HRA may be an acceptable treatment option for FNFs in the non-ambulator.

Level of evidence: IV

• arthroplasty
• hip
• outcomes
• pelvic discontinuity
• pelvic dissociation
• revision
• treatment

This is a case of a 54-year-old woman managed as a case of osteogenesis imperfecta type 1 who sustained a left subtrochanteric fracture and eventual ankylosis of both hips after surgery and immobilisation. These injuries rendered her bedridden, maximally assisted in transitions and transfers, and unable to be positioned past 30° of backrest elevation. The patient underwent a bilateral Girdlestone procedure and had tailored progressive postoperative rehabilitation in both the inpatient and outpatient settings. The patient also continued to receive bisphosphonates during her preoperative and postoperative period, to improve bone stock and aid in relieving pain. Through the efforts of a team of physiatrists, geneticists and orthopaedic surgeons, the patient was able to achieve pain-free sitting, independent transitions and short-distance ambulation, which have allowed her to care for herself more effectively and return to her work and activities of daily living.

• genetics
• orthopaedics
• rehabilitation medicine