Girdlestone procedure: when and why.

Area of Science:

• Orthopedic Surgery
• Infectious Disease Management

Background:

• Infected hip arthroplasty presents a significant clinical challenge.
• The Girdlestone procedure is a recognized treatment option alongside others like antibiotics, debridement, and exchange arthroplasty.
• Treatment selection requires careful consideration of multiple patient-specific factors.

Purpose of the Study:

• To review the outcomes and indications for the Girdlestone procedure in managing infected hip arthroplasty.
• To synthesize reported results regarding patient satisfaction, infection control, pain, and functional status.
• To delineate absolute and relative indications for considering the Girdlestone procedure.

Main Methods:

• Literature review of studies reporting on the Girdlestone procedure for infected hip arthroplasty.
• Analysis of reported patient satisfaction rates, infection healing percentages, pain levels, and functional outcomes (e.g., Harris Hip Scores, ambulation).
• Compilation and categorization of indications for the procedure, distinguishing between absolute and relative criteria.

Main Results:

• Patient satisfaction with Girdlestone outcomes varies widely (13% to 83%).
• Infection healing rates are generally high (80% to 100%), but lower in specific subsets (e.g., rheumatoid arthritis, enterococcal infections, retained cement).
• Significant variability exists in reported pain levels and functional outcomes, with a notable percentage of patients experiencing severe pain or impaired mobility, particularly in geriatric populations.

Conclusions:

• The Girdlestone procedure offers a high rate of infection control for infected hip arthroplasty but with unpredictable patient satisfaction and functional outcomes.
• Careful patient selection based on absolute indications (non-ambulatory status, high reimplantation risk) and relative indications (dementia, immunocompromise, substance abuse) is crucial.
• Further research may be needed to optimize patient selection and manage expectations regarding pain relief and functional recovery after Girdlestone procedures.