title: Modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov external fixator as a salvage method in the management of severely infected total hip replacement.
abstract: BACKGROUND
  Resection arthroplasty or hip arthrodesis after total hip replacement (THR) can be used to salvage the limb in case with deep infection and severe bone loss. The Ilizarov fixator provides stability, axial correction, weight-bearing and good fusion rates.
  
  
  METHODS
  We retrospectively assessed the outcomes of 37 patients with severe periprosthetic infection after THR treated between 1999 and 2011. The treatment included implant removal, debridement and a modified Girdestone arthroplasty (29 cases) or hip arthrodesis (seven cases) using the Ilizarov fixator. The Ilizarov fixation continued from 45 to 50 days in the modified arthroplasty group and 90 days in the arthrodesis group. One case was treated using the conventional resection arthroplasty bilaterally.
  
  
  RESULTS
  Eighteen months after treatment, infection control was seen in 97.3% cases. Six hips were fused as one patient died in this group. Limb length discrepancy (LLD) averaged 5.5 cm. The Harris hip score ranged from 35 to 92 points. Hip joint motion ranged from 10° to 30° in the modified arthroplasty group. All subjects could walk independently or using support aids. No subluxation or LLD progression was observed.
  
  
  CONCLUSIONS
  The modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov apparatus results in sufficient ability for ambulation and good infection control in cases of failed THR associated with severe infection.
authors.affiliation: Bone Infection Clinic, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan 640014, Russian Federation, Russia.
authors.forename: Nikolai M
authors.initials: NM
authors.lastname: Kliushin
authors.affiliation: Department of Bone Infection, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan 640014, Russian Federation, Russia.
authors.forename: Yuri V
authors.initials: YV
authors.lastname: Ababkov
authors.affiliation: Department of Bone Infection, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan 640014, Russian Federation, Russia.
authors.forename: Artem M
authors.initials: AM
authors.lastname: Ermakov
authors.affiliation: Department of Scientific Medical Information, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan 640014, Russian Federation, Russia.
authors.forename: Tatiana A
authors.initials: TA
authors.lastname: Malkova
keywords: Arthrodesis; Arthroplasty; Girdlestone arthroplasty; Ilizarov; arthodesis; hip; infection; replacement; total hip replacement