A total of 31 patients, (20 women, 11 men; mean
age 62.5 years old; 23 to 81), who underwent conversion of a Girdlestone
resection-arthroplasty (RA) to a total hip replacement (THR) were
compared with 93 patients, (60 women, 33 men; mean age 63.4 years
old; 20 to 89), who had revision THR surgery for aseptic loosening
in a retrospective matched case-control study. Age, gender and the
extent of the pre-operative bone defect were similar in all patients.
Mean follow-up was 9.3 years (5 to 18). Pre-operative function and range of movement were better in the
control group (p = 0.01 and 0.003, respectively) and pre-operative
leg length discrepancy (LLD) was greater in the RA group (p <
0.001). The post-operative clinical outcome was similar in both
groups except for mean post-operative LLD, which was greater in
the study group (p = 0.003). There was a significant interaction
effect for LLD in the study group (p <
0.001). A two-way analysis
of variance showed that clinical outcome depended on patient age
(patients older than 70 years old had worse pre-operative pain,
p = 0.017) or bone defect (patients with a large acetabular bone
defect had higher LLD, p = 0.006, worse post-operative function
p = 0.009 and range of movement, p = 0.005), irrespective of the
group. Despite major acetabular and femoral bone defects requiring complex
surgical reconstruction techniques, THR after RA shows a clinical
outcome similar to those obtained in aseptic revision surgery for
hips with similar sized bone defects. Cite this article:
There are few reports of the surgical treatment for late stage Freiburg’s disease with flattening of the metatarsal head and osteoarthritis. We describe the results of the surgical treatment of ten consecutive patients with advanced stage Freiburg’s disease (Smillie’s stage V), using a technique that has not been published previously.
