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LETTER
Year : 2014  |  Volume : 60  |  Issue : 2  |  Page : 222-223

In defence of Girdlestone excision arthroplasty: A comment on 'Unusual way of loosened total hip arthroplasty treatment with an Austin Moore endoprosthesis'


1 Department of Orthopedics, Melaka-Manipal Medical Collage, Melaka, Malaysia
2 Senior Lecturer (Orthopaedics), Newcastle University Medicine, Malaysia
3 Department of Orthopedics, JIPMER, Pondicherry, India
4 Kasturba Medical College Hospital, Mangalore, Karnataka, India

Date of Web Publication13-May-2014

Correspondence Address:
Dr. N K Sinha
Department of Orthopedics, Melaka-Manipal Medical Collage, Melaka
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.132388

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How to cite this article:
Sinha N K, Bhardwaj A, Poduval M, Rao B S. In defence of Girdlestone excision arthroplasty: A comment on 'Unusual way of loosened total hip arthroplasty treatment with an Austin Moore endoprosthesis'. J Postgrad Med 2014;60:222-3

How to cite this URL:
Sinha N K, Bhardwaj A, Poduval M, Rao B S. In defence of Girdlestone excision arthroplasty: A comment on 'Unusual way of loosened total hip arthroplasty treatment with an Austin Moore endoprosthesis'. J Postgrad Med [serial online] 2014 [cited 2019 Nov 17];60:222-3. Available from: http://www.jpgmonline.com/text.asp?2014/60/2/222/132388


Sir,

We read with interest the article titled 'Unusual way of loosened total hip arthroplasty treatment with an Austin Moore endoprosthesis'. [1] We commend the extensive surgical effort of the authors made in a crunch situation. It was a case of failed hip prosthesis with bony erosion and peri-prosthetic pathological fracture. The authors have enlisted two options for this case and have preferred the second one with exchange prosthetic replacement. It included the meticulous removal of cement followed by application of cemented Austin Moore prosthesis and dual plating. However, the use of prosthetic head in acetabulum with the bone loss has resulted in protrusio acetabuli [fourth picture]. At present; the patient is mobile on crutch. There is no mention of the presently available range of movement of the hip joint. However, as the fourth picture suggests, there may be little mobility in the hip joint due to sinking of the prosthetic head and peri-articular ossification.

What would have been the final outcome if the authors had chosen the first option and managed the pathological fracture of proximal femur with minimal hardware as needed? It would have essentially behaved as Girdlestone excision arthroplasty (GEA). This surgical option has a good long-term outcome in the failed hip cases. [2],[3],[4],[5] Patient's satisfaction in terms of the pain relief and mobility is high, when GEA is performed as a secondary procedure in a unilateral case like the present case. [2] It is a time-tested procedure to the control infection in cases of infected prosthetic replacement. However, it can be used in case of implant loosening. [3],[5] It obviates the use of cement and prosthesis, which can have prosthesis-related complications and higher incidence of infection. Presence of retained bone cement does not impact wound healing and the late outcome of the surgery in cases of implant loosening. [3] GEA does not stress the eroded acetabulum. Half of the operated case can walk with no aid or one stick, if postoperative skeletal traction is continued for 6 weeks. [2] The satisfaction percentage as noted by the patient has ranged from 59.3 to 95.5. [3],[4],[5]

 
 :: References Top

1.Erceg M, Becic K. Unusual way of loosened total hip arthroplasty treatment with an Austin Moore endoprosthesis. J Postgrad Med 2014;60:81-3.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Haw CS, Gray DH. Excision arthroplasty of the hip. J Bone Joint Surg Br 1976;58:44-7.  Back to cited text no. 2
[PUBMED]    
3.Go³da W, Pawelec A, Walczak J. Clinical results evaluation of the Girdlestone's procedure after hip arthrography. Ortop Traumatol Rehabil 2001;3:68-70.  Back to cited text no. 3
    
4.Esenwein SA, Robert K, Kollig E, Ambacher T, Kutscha-Lissberg F, Muhr G. Long-term results after resection arthroplasty according to Girdlestone fortreatment of persisting infections of the hip joint. Chirurg 2001;72:1336-43.  Back to cited text no. 4
    
5.Sharma H, Kakar R. Outcome of Girdlestone's resection arthroplasty following complications of proximal femoral fractures. Acta Orthop Belg 2006;72:555-9.  Back to cited text no. 5
    




 

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2004 - Journal of Postgraduate Medicine
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