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Analysis of clinical data in patients with Girdlestone arthroplasty: a new score
L Molfetta1, M Bassetti, M Benvenuti
1School of Medicine, Orthopaedic Clinic, University of Genoa, Genoa, Italy.
Insights
Girdlestone
Area of Science:
- Orthopedic Surgery
- Infectious Disease Management
Background:
- Girdlestone's arthroplasty is an uncommon but necessary procedure for complex hip conditions, including recurrent infections and multiple revisions.
- Rising hip replacement numbers correlate with increased prosthesis infections, necessitating awareness of salvage procedures like Girdlestone's arthroplasty.
- Standard hip assessment scores are inadequate for evaluating Girdlestone's arthroplasty outcomes due to common complications like instability and muscle loss.
Purpose of the Study:
- To introduce a novel clinical scoring system specifically designed for assessing Girdlestone's arthroplasty outcomes.
- To highlight the importance of Girdlestone's arthroplasty as a viable option for specific hip pathology cases.
- To provide a tool for objective patient evaluation in clinical trials and legal medicine contexts.
Main Methods:
- Development and proposal of a new clinical score tailored to the unique challenges of Girdlestone's arthroplasty.
- Presentation of a case series of 20 Girdlestone's arthroplasty procedures out of 265 hip revisions.
- Clinical assessment of patient outcomes based on the proposed scoring system.
Main Results:
- The proposed clinical score demonstrated adequacy in assessing patient presentation after Girdlestone's arthroplasty.
- Out of 20 cases, outcomes were classified as clinically good in 8, intermediate in 10, and bad in 2.
- The study supports the justification of Girdlestone's arthroplasty when indicated by specific clinical signs.
Conclusions:
- A specific clinical score is crucial for evaluating Girdlestone's arthroplasty, addressing limitations of existing hip rating scales.
- The proposed score offers a reliable method for assessing outcomes, aiding comparative studies and clinical decision-making.
- Girdlestone's arthroplasty remains a valuable surgical intervention for carefully selected patients with severe hip problems.
Abstract:
Girdlestone's arthroplasty is an uncommon surgical procedure; it is performed in patiens with recurrent infection of the hip, polymicrobic sepsis or after multiple revisions. The number of hip replacements all over the world is always increasing, so the total number of prosthesis infections also continues to rise, although the relative incidence is lower than in the past. For this reason Girdlestone's arthroplasty must be a well-known procedure to hip surgeons. Clinical assessment of such patients cannot be performed with common hip ratings (e.g. Harris Hip Score) since hip instability, low range of motion, limb shortening and severe muscle loss are common. The patient's independence in daily living activity and freedom from pain should be the surgeon's main goals. We propose a specific clinical score for the outcome of the procedure, which is not to be found in the current literature as far as the authors are aware. The score can be useful for comparative clinical trials, for legal medicine purposes, etc. To illustrate it, we present 20 cases of Girdlestone's arthroplasty out of 265 hip revisions performed in our hospital. The outcome of the procedure in our patients was clinically good in eight cases, intermediate in ten cases, and bad in two cases. We believe the performing of such an intervention is justified when indicated by clinical signs, as we analyse them in our work. Our clinical score has been shown to be adequate to assess the clinical presentation of such patients.
