Girdlestone Resection Arthroplasty

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Original Editor - Kirsten Coutts

Top Contributors - Kirsten Coutts and Lucinda hampton  

History

This surgical procedure was first described by an English Orthopaedic surgeon, Gathorne Robert Girdlestone in 1928. The procedure has been known by his name ever since. It was first used for chronic septic arthritis of the hip, mostly arising from Tuberculosis. As there was not yet good access to antibiotics and arthroplasty, this procedure was used to resect the femoral head, to relieve the pain and source of infection.

The method and techniques used in this surgery have evolved over time.

Description

The first documented surgery of this kind, in 1928, involved radical excision to drain the tuberculous hip. A transverse incision of 5-6 inches (12-15cm) long with its centre near the greater trochanter is made, which exposes the gluteal muscles and fascia. All deep tissues, including greater trochanter and the gluteal muscles are removed. A transfer wedge is removed to allow the surgeon access to the joint and surrounding area. All decayed bone and septic debris is removed. The cavity is packed with gauze wicks and rubber drains to ensure drainage and control secondary granulation. The skin flaps are drawn back and stitched into the periosteum to prevent sinus-track from forming, to reduce the pain of dressings and allowing covering of the raw areas with excessive granulation.The subcutaneous and muscle tissues are largely covered, decreasing the granulating surface. Lastly, a spica splintage was fitted for the patient. The 3 main goals of this surgery was to remove dead and devitalised tissues, flatten down dead spaces, and allow drainage so the wound would heal from the bottom.

The surgery described above is mostly no longer used thanks to modern medicine and better infection control measures. It is however still used as a salvage procedure in many cases:

• Patients where mobility is poor (such a non-ambulatory cerebral palsy patients who often have persistent pain and chronic hip dislocation and subluxation . This allows pain relief, improvement of sitting balance and better perineal care.

Total hip arthroplasty(THA) gained success in the 1960s when it was developed by Sir John Charnley. Since then it has evolved and advanced in many ways and the number of THAs all over the world is high. The main concern of a THA is infection. As a last resort for infection, the GRA is used to completely remove the hip prosthesis without replacement. An incision is made though the fascia lata and gluteal musclesm the joint capsule is released and the femoral stem is removed. The bone marrow is cleaned and flushed, the would is closed with a drain inserted. This leaves only a crude articulation between femur and acetabulum. The proximal femur migrates 5-10cm cranially, and finds support at the abductor muscles. It also exorotates due to the shape of the pelvis. The patient is left with a leg length discrepancy (LLD).

The second option available is to use Girdlestone resection arthoplasty (GRA) as part of a two-stage revision arthroplasty.

Once the femoral head has been resected, the clinical situation that remains is referred to as the 'Girdlestone situation'.

Also referred to as : Hip resection arthroplasty, Girdlestone procedure, Girdlestone excision arthroplasty of Hip and Femoral head ostectomy.

Indication

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Clinical Presentation

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Diagnostic Tests

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Pre-Op

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Post-Op

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Resources

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