The Girdlestone Procedure for the Treatment of the Septic Hip Joint

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Authors:Zalavras CG, Papasoulis E, Holtom PD, Rigopoulos N, Zahos K, Patzakis MJ.
University of Southern California, Los Angeles, CA

Title: The Girdlestone Procedure for the Treatment of the Septic Hip Joint

Background: Excision arthroplasty of the hip (Girdlestone procedure) is considered a salvage procedure for severe infections involving the hip. However, there is limited and variable information in the literature on success of the procedure in controlling infection and on patient functional outcome.

Hypothesis/Purpose: The aim of this study was to evaluate excision arthroplasty as definitive treatment in compromised patients with comorbidities who were not considered candidates for total hip arthroplasty.

Methods: This is a retrospective study of 24 adult patients treated in our institute with a Girdlestone procedure for hip joint infections. There were 18 male and 6 female patients and their mean age was 50 years (34 to 73 years). Comorbidities were present in all patients (100%). Intravenous drug abuse (33%), diabetes (33%), and liver disease (21%) were most commonly found. There were 15 cases of hematogenous osteomyelitis and 9 postoperative implant infections (5 following fracture fixation and 4 following arthroplasty procedures). C-reactive protein (CRP) was elevated in 96% of patients (mean 144 mg/L) and erythrocytre sedimentation rate (ESR) in all of them (mean 109 mm/hr). Staphylococcus aureus was the most common pathogen, isolated in 58% (14/24) of cases with 50% (7/14) of organisms oxacillin-resistant. Antibiotics were administered for 6 weeks postoperatively. Mean follow-up was 37 months (12 to 108 months).

Results: Control of infection was achieved in 88% (21/24) of patients after the index procedure and in 96% (23/24) following repeat debridement. Fifty eight percent of patients were pain free, 17% had mild pain (1-4 in the visual analog scale[VAS]), and 25% had moderate pain (5-7 in the VAS). Mean leg length discrepancy was 4.7 cm (2.5 to 7.2 cm). Twenty-one (88%) of 24 patients were able to ambulate (19 using an assistive device and 2 independently), whereas the remaining 3 patients used a wheelchair.

Discussion: Excision arthroplasty as definitive treatment for hip joint infections controls infection, provides pain relief, and allows ambulation in most patients. Hip arthroplasty in the setting of previous hip infection carries increased risk of re-infection, especially in patients with comorbidities.

Conclusion: Excision arthroplasty is a viable alternative for the management of hip infection in compromised hosts.