Girdlestone resection arthroplasty following failed surgical procedures

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.