Girdlestone resection arthroplasty – A limb salvage procedure after failed hip surgery in a rural setup

Background: Excision arthroplasty of the hip was first documented in surgical practice over a century ago. However, it was made popular in 1943 by Gathorne Girdlestone who used the technique for the treatment for septic arthritis of the hip.1 Thus his name has been synonymous with the procedure, which is currently used to address problems arising from failed hip surgery including peri-prosthetic infections or recurrently dislocating prostheses. Materials & Methods: Between 2001 and 2016, the case notes and theatre charts of 57 patients who had undergone Girdle stone resection arthroplasty were reviewed retrospectively. The indications were sepsis after a hip arthroplasty in 35 cases, aseptic loosening of the prosthesis in 5, recurrent dislocation of a hip arthroplasty in 2 and failed internal fixation of a femoral neck fracture in 15. The final subjective outcome was evaluated by questionnaire performed by a single assessor. Subjective assessment was recorded in terms of pain, leg length discrepancy, functional activities, infection control, use of a walking aid, walking ability and overall satisfaction status according to Harris Hip Scoring Questionnaire. Results: After recovery from operative intervention 33% of patients experienced mild pain to no pain at all and were considered to have adequate pain control. Finally, 79.16% were happy with the outcome, 12.5% of patients were unhappy with the long-term result, and 8.33% were indifferent. Conclusions: This study found that the Girdlestone resection arthroplasty was a viable option to salvage irreversibly failed operated hip fractures in medically and economically suboptimal patients in rural setup.