The Girdlestone procedure in spinal cord injured patients: a ten year experience

The Girdlestone procedure which originally was developed for the treatment of tuberculosis of the hip has found a place in the management of septic hip arthritis and osteomyelitis secondary to pressure sores in spinal cord injury and other myelopathies. Eradication of the septic focus is necessary if amyloid disease is to be prevented. Early diagnosis and aggressive surgery are essential. Surgical treatment entails not only bone removal, but also a thorough joint debridement. This procedure goes hand-in-hand with the appropriate antibiotic treatment given intravenously for an adequate time (4-6 weeks). When available, hyperbaric oxygen therapy is a good treatment. It is important to obliterate a large pseudoarthrosis cavity by muscle transfer from the thigh using a hamstring or a vastus lateralis. Irrigation, suction and drainage are important until the would heals. In summary, 39 patients had 42 Girdlestone procedures without any operative mortality. Seventy percent of the wounds had healed and 30% failed to heal requiring another operation. Recurrences were observed in 10% of the patients, and these cases needed another operation together with hyperbaric oxygen therapy. Eight patients died due to other causes unrelated to the operation. The procedure is rather simple but needs prolonged postoperative care, especially with wound failure or recurrences.