Clinical results evaluation of the Girdlestone's procedure after hip arthrography

Background. To date very little work has Bern done on the clinical evaluation of the hip in patients who hale ultimately has a prosthesis removed. This operation, known in English as the Girdlestone procedure, is referred to in Poland as "pendent hip". The present authors have evaluated clinical outcomes of this procedure, taking into account its "rescue" nature.
Material and methods. 22 patients were evaluated, ranging in age from 68 to 87 years, operated in our Clinic between 1979 and 1999 (women: 62,8%; averageage of patientswhen the Girdlestone procedure was performed: 67,2 years). The average observation period after removal of the endoprosthesis was 5,2 years (ranging from 1 to 21 years). The anterolateral approach to the hip joint was used. On each occasion the wound was closed with layer sutures, leaving 4 drains. Postoperative limb traction was maintained for a period lasting form 2 to 4 weeks. The patients were allowed to walk after 4 weeks, with progressively increased load on the operated leg. Clinical evaluated of "pendent hip" was performed using the Harris scale. Shortening of the operated leg (in cm) was also included as well as successful treatment of inflammation (for a period of at least I year) with normalization of the biochemical markers of infection X-ray examinations included periarticular calcification, the remains of cement, and the degree of proximal displacement after surgery on the proximal end of the femur. The patient's subjective evaluation was also included in the overall outcome.
Results. The outcome of surgery was evaluated as good by 12 patients (54,6%), and as satisfactory by 9 (40,9%). These patients did not fully accept the shortening of the limb, the relatively small range of motion, and the need for permanent orthopedic aids (orthopedic shoes to compensate for shortening and elbow cruthes). 1 patient evaluated the outcome as poor due to persistent infection. In 95,5% of the sases the Girdlestone procedure freed the patients of infection and pain, or noticeably reduced it. Only in 1 case did it prove impossible to manage infection completely (4,5%). 18 patients had shortened limbs > 3 cm, while insufficiency of the buttock muscles with positive Trendelenburg and Duchenne signs were the cause of great difficulties and rapid fatigue during walking. The average evaluation of pendent hip using the Harris scale was 58,6 points. In radiological evaluation we often encountered the remains of bone cement. In the case of aseptic loosening this had no impact on the healing process and the late outcome of surgery. Only in I case did it prove impossible to control infection without complete removal od fragments of bone cement. Osteoporosis of the pelvis and proximal end of the femir was found in all patients.
Conclusion. The Girdlestone procedure is a sensible rescue technique both for infected hip prostheses and in situation where reimplantation of the prosthesis is technically impossible.