GIRDLESTONE ARTHROPLASTY PDF
Girdlestone procedure is excision arthroplasty of hip in which femoral head, neck, proximal part of trochanter and the acetabular rim are removed. Modern technological advancements in revision hip arthroplasty have revolutionised the treatment of failed primary total hip replacements. The decision to. Girdlestone resection arthroplasty should be considered as a salvage procedure, primarily aimed at pain relief and infection control. Such patients must be.
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Girdlestone procedure is excision arthroplasty of the hip in which femoral head, neck, Proximal Nearer to the trunk. Shoulder is proximal and elbow is distal. The procedure was described for chronic deep-seated infections of the hip joint.
Girdlestone procedure also goes by name of excision arthroplasty of the hip, femoral head ostectomy or Girdlestone resection arthroplasty is an excision arthroplasty of the hip. The procedure was developed by British surgeon Gathorne Girdlestone as a lifesaving measure to remove disease and devitalized tuberculous hips in the pre-antibiotic era. The year was The patient is put on skeletal traction in 30 to 50 degrees of Abduction It is a movement in coronal plane.
Movement away from the central axis. It is opposite to adduction. The traction is kept for 3 months. The patient is encouraged to sit soon after the operation, and repetitive active assisted movements of the hip and knee are started during the first week.
Active physiotherapy and exercises in traction help patients to develop good muscle power, the maximal range of hip movements. After traction, the patient is encouraged to bear weight and use hip for squatting and sitting cross-legged. The weight is borne using a weight-relieving caliper and crutches which is continued for months. After that, walking with a walking stick is started. Traction and bracing during walking keeps cut the upper end of the femur and the outer surface of acetabulum apart from one another.
This allows an adequate layer of fibrous tissue is more likely to form over both. This thereby providing more ideal surfaces for a pseudarthrosis. Shortening of the limb is inevitable with Girdlestone procedure. The mean loss of length by this technique is 1. For optimum results regimen of postoperative care is essential. Overall, Girdlestone arthroplasty provides an unstable pain-free hip.
The walking and standing tolerance vary from patient to patient. Some degree of telescoping of the limb and a tendency toward external rotation are not uncommon. At times the degree of function is good. Excision arthroplasty may rarely leave behind a very unstable hip joint. This generally happens where the disease has healed with minimal fibrosis and scarring of the capsule and soft tissues.
Such patients may require hip stabilization procedures may be done 3 to 6 months after the Girdlestone operation. The acceptance of Girdlestone procedure is more in people who are accustomed to floor level activities like squatting and sitting cross-legged.
Girdlestone procedure is mostly done for the tubercular hip. But there is an increasing trend towards performing replacement surgery in these patients.
Replacement surgery is more acceptable procedure across the races as it provides stable, pain-free hip, with functions close to the original hip.
As the drugs become more effective and revision arthroplasty yielding better results, in cases of infected prosthesis antimicrobial, definitive excision arthroplasty has become a salvage operation. It is generally reserved for those with significant girdlstone or in cases where the revisions have repeatedly failed.
The trend of Girdlestone procedure is declining but it remains a valuable surgery in select cases. Subscribe to our Newsletter and get latest publications on Musculoskeletal Health your email inbox. We respect your privacy and take protecting it seriously. Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. This website is an effort to girdlextone and support people and medical personnel on orthopedic issues and musculoskeletal health.
Will I be able to walk normally or will I still have a bad limp with pain. We do follow Girdlestone procedure with skeletal traction. That is how procedure has been described and done at all the centers I did attend.
Whether there is some recent evidence to the contrary, I am not aware.
Still I would look up and let you know in due course. I checked and found studies reporting that they found no difference in functional outcomes or limb shortening between the patients who underwent skeletal traction for 3 weeks and those who had early mobilization without skeletal traction.
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Could you please confirm as how much time it will take to walk with a suitable crutch support and without support. Hem may take anytime between months to walk with support. Gradually he might leave the support though that is not advised. My friend underwent a left hip Girdlestone aratroplasty with tendon releases in July He was girrdlestone placed on a skeletal traction nor arthropoasty to rehab instead he was discharged 4 days later to come to his arghroplasty home.
On October 5, he had a right hip fracture. He did not fall or sustained any injuries. Please can you help me understand how this could happen?? It is impossible to imagine what causes injury in case a clearcut history of trauma is present.
If so then forces that girdlestlne on hip could result in the fracture especially when the hip is weak. If the hip is weak even an action like standing from a sitting position may result in a break and further forces cause further injury.
Singh My uncle had a girdlestone procedure in May because of two failed ortho procedures to repair a fractured femur. Due to his age 88 he is basically bedridden, however today I noted that the affected thigh is much larger than the normal leg and he experienced pain when I moved the leg.
He is diabetic but I was wondering that after one year five months the healing process would have been over. His temperature is normal so I do not think he has an infection and the thigh feels normal to touch — no redness or hotness. Any suggestions or ideas as to what could be happening?
Girdlestone Procedure or Excision Arthroplasty of Hip | Bone and Spine
Intend to ask his doctor if an ultrasound or x-ray would help to clarify. A swelling should be examined and investigated. In old age and immunocompromised states such as diabetes, it is not always necessary to have systemic symptoms like fever etc.
Moreover, not all local infections have identifiable systemic features. I am not saying it is an infection.
I am girdlestne pointing that the premise on which you assured yourself that infection is absent may not entirely hold. Your email address will not be published.
By using this form you agree with the storage and handling of your data by this website. This site uses Akismet to reduce spam. Learn how your comment data is processed. Subscribe to our Newsletter and get updates delivered to your email inbox. Nearer to the trunk. Away from the median plane. Examples Fibula is lateral to tibia bone.
It is a movement in coronal plane. Get more stuff on Musculoskeltal Health Subscribe to our Newsletter and get latest publications on Musculoskeletal Health your email inbox.
John Peel, We do follow Girdlestone procedure with skeletal traction. Meanwhile, you can have a discussion with your treating doctor. I hope that helps. Awaiting for your response. Ishaq Khan, Hem may take anytime between months to walk with support. A sudden twist or jerk during walk may also be responsible.
A discussion with the doctor who is seeing him might help you further. Please get him examined and investigated. Leave a Reply Cancel reply Your email address will not be published. Get more on Musculoskeletal Health in your inbox Subscribe to our Newsletter and get updates delivered to your email inbox.