[Resection of head and neck of the femoral bone according to Girdlestone].
OBJECTIVE
To present our experience with resection arthroplasty of the hip joint according to Girdlestone, as the primary surgical technique used to treat various hip disorders.


METHODS
During 1990 to 1999, 28 hips in 26 patients were treated in our department by resection arthroplasty according to Girdlestone. The most frequent indications for resection arthroplasty included pyogenic arthritis of the hip, tuberculous arthritis of the hip, post-traumatic pseudoarthrosis and avascular necrosis of the head, hip ankylosis following injury to the thoracic spine, and painful restriction of motion in cerebral palsy. In 2000, 20 hips were evaluated in 19 patients (11 men and 8 women; mean age at the time of surgery, 59.4 years; range, 18 to 79 years). The average time between the operation and evaluation was 3 years and 7 months. Seven patients were lost to follow-up; two died from unrelated causes, four underwent reimplantation of the hip prosthesis at an average of 13 months after the primary resection, and one patient failed to turn up.


METHODS
Each patient was examined for the range of motion in the hip joint and limb length, and the questionnaire was completed. The Harris hip scores were used to evaluate joint function.


RESULTS
Of the 19 patients, six (33%) were free from pain, ten (53%) occasionally used analgesics for relief of mild to moderate pain, and three (16%) reported severe pain restricting their daily activities. All patients were using walking aids, five (26%) had one French crutch and 11 (58%) had two crutches. Two patients (11%) were able to move only with a walking frame and one patient was confined to a wheel chair because of paraplegia due to thoracic spine injury. The shortening of affected limbs ranged from 1.5 cm to 6.5 cm (mean, 3.8 cm). All patients showed the Trendelenburg sign. Passive flexion in the treated hip ranged from 40 degrees to 130 degrees. The average Harris score was 64 points (range, 25 to 83 points). None of our patients achieved an excellent outcome.


CONCLUSIONS
The use of the Girdlestone resection arthroplasty aims at pain alleviation, improvement in hip function, cure of infection, if this is present, and patients' satisfaction. The results described in the literature vary from bad to excellent. The evaluation of patients' satisfaction ranges from 14% in the study by Petty et al. to 100% described by Böhler and Salzer. In our group, 74% of the patients were satisfied with the surgical outcome, which is in agreement with 74%, 79% and 77% reported by Ballard et al., Bourne et al., and Haw and Gray, respectively. Most authors agree that the Girdlestone technique provides alleviation of pain in the treated hip; 84% of our patients reported pain relief. Although resection of the femoral head resulted in a considerable shortening of the affected limb (up to 4 cm), 84% of all our patients were able to walk with the use of some support. The issues open to dispute are the duration and method of post-operative extension. We do not consider skeletal traction to be necessary. We found no difference in functional outcomes or limb shortening between the patients who underwent skeletal traction for 3 weeks and those who had early mobilization without skeletal traction.


CONCLUSIONS
Young and active patients with a single affected joint usually do not want to accept pseudoarthrosis as a definitive outcome. On the other hand, older patients with concomitant disorders or diseases are often willing to come to terms with pain-free hip pseudoarthrosis.
I. ortopedická klinika FN u sv. Anny, Brno.
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Stoklas
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Rozkydal
D000293:Adolescent; D000328:Adult; D000368:Aged; D001178:Arthroplasty / Q000379:methods*; D005260:Female; D005270:Femur Head / Q000601:surgery*; D005272:Femur Neck / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged