Early reports on revision total hip arthroplasty (RTHA) suggested that outcomes of this procedure are as good as those of primary total hip arthroplasty (THA). However, RTHA is associated with longer surgery time, greater blood loss and increased risk of complications (thromboembolism, nerve injury, periprosthetic fractures, recurrent hip dislocations and infections). Aseptic loosening after RTHA was reported in 36% of patients aged over 55 years within 4 years after revision. Infections were reported in 32% and complications during surgery in 23% of patients respectively. Unsatisfactory results of RTHA stimulate the search for alternative procedures. Girdlestone excision arthroplasty (GA) seems to be a good solution for older patients with high risk of complications related to a poor general condition.
Material and method Between 2000 and 2003 we operated 39 patients, 10 for septic (26%) and 29 aseptic (74%) loosening of their THA. All patients complained of painful limb aggravated by weight bearing and the severity of pain was the main indication for the surgery. Average survival time of previous THA was 9 year (range: 1 to 20). We assessed pain, walking distance and the need to use walking aids. The outcomes were measured according to the Harris Hip Scale. The patients had the GA performed. The procedure involved removing implant and bone cement and placing the major trochanter into bone acetabulum. If an infection was present, an antibiotic irrigation system was introduced. No cast or braces were used and walking was started 2–7 days after surgery, depending on patients general condition.
Results Good pain control was reported by 33 (85%) patients. The average Harris Hip Score changed from 25 points preoperatively to 53 at latest follow-up. Average limb shortening was 4 centimetres (range: 2 to 8). Walking aids (one or two crutches) were required by all patients. Eighteen (46%) patients walked more than 500 m, 12 (31%) patients walked 200–500 m and 9 (23%) patients walked less than 200 m, of whom one patient was wheelchair bound.
Infection ceased in 9 cases, 1 patient died because of complications related to chronic infection.
Discussion GA yields satisfactory results in patients who have to have their prostheses removed. It provides a mobile, painless joint. The disadvantages of GA are: limb shortening and unstable gait which requires the use of crutches. This procedure should be indicated for patients with high risk of complications due to poor general health, infection and/or massive loss of bone stock which render more invasive procedures impossible. GA is also advisable in patients with weak hip abductor muscles, when RTHA is associated with a high risk of recurrent hip dislocation. The Girdlestone arthroplasty is a satisfactory salvage procedure in most cases of failed THA, when the choice of reimplantation exposes the patient to a high risk of further failure.
