Is There a Place for Girdlestone's Excision Arthroplasty in Modern Treatment of Hip Pathology? A Multi-Institutional Retrospective Study on the Indications and Outcome

Abstract

Background /Objectives: Primary Resection Arthroplasty as described by Girdlestone is not a common procedure done nowadays and is currently reserved for the treatment of septic hip and prosthetic implant infection and as a salvage procedure when reconstruction is impossible primarily for
control of pain. The aim of this study is to retrospectively evaluate the indications for and the outcome as a primary surgical technique and evaluate the usefulness in a technically advancing world of total hip arthroplasty.
Materials and Methods: This is a ten year retrospective study (2000-2009) carried out at five hospitals in North Central, Nigeria. Case notes were reviewed and patients that met a set of criteria and had a minimum follow-up of 24 months were recruited. Outcome measures were limb length discrepancy (LLD), hip control, pain control, muscle stiffness and satisfaction obtained. Visual Analogue scale (VAS) and Harris Hip Score(HHS) were also computed. All analysis was done on Epi-Info version 3.5.1(2008) with means all to one decimal place.
Results: Thirty-nine patients out of 51 patients met the inclusion criteria comprising 27(69.2%) males and 12(38.8%) females with a mean age of 52(±17.6) years. The indications were severe osteoarthritis 18(46.2%); fracture neck of femur 7(17.9%); neglected fracture-dislocation of the hip in 6(15.4%); avascular necrosis of the femoral head in 5(12.8%) and septic arthritis in 3(7.7%). The pre-operative LLD was 1.89±0.8 (range 1-4cm) compared to post operative LLD of 4.3(range 3-5cm). Pre-operative VAS was 7±1 and post operative was 1±0.8. Pre-op HHS was 46±10 compared to post-op score of 79±3(mode 81). Fifteen(38.5%) had good hip control, 14(35.9%) had some control requiring walking stick for long distance walk and 10(25.6%) had poor control and required walking stick for walking. Age (p<0.05) and indications (p<0.05) significantly affected outcome. Twenty (51.3%) had no pain post operatively, 18 (46.2%) had mild pain but no need for analgesics and one(2.6%) had mild pain requiring occasional analgesics. Fourteen (35.9%) were satisfied and happy, 18(46.2%) felt better but actually expected more while seven (17.9%) were not satisfied at all.
Conclusion: GRA is very good for pain control otherwise it is associated with poor outcome found to be unsatisfactory to most patients.

Keywords: Girdlestone Resection Arthroplasty, hipprosthesis, Pain control, satisfaction.