Outcome of Girdlestone's resection arthroplasty following complications of proximal femoral fractures.

Twenty two patients who underwent a Girdlestone resection arthroplasty of the hip (pseudarthrosis coxae) following failed operative treatment for hip trauma from 1993 to 2002 were retrospectively reviewed. The indications included failed osteosynthesis of fractures of the neck of the femur (n=8), septic hemiarthroplasty (n=9), aseptic loosening of hemiarthroplasty (n=3) and recurrent dislocation of a hemiarthroplasty (n=2). The mortality was 68.2% (15 patients, mean age: 78.8 years, 80% females) with a mean time interval between operation and death of 25.6 months. All the seven surviving Girdlestone patients had failed hemiarthroplasties previously. One of these had subsequently undergone re-implantation of a femoral prosthesis, and was excluded from the study. There were four females and two males. The age ranged from 62 to 94 years with a mean age of 79.6 years. There were 4 right-sided and 2 left-sided operations. The patients were followed-up for a mean 37.1 months (range : 6 months to 8 years). Pain relief was achieved in 100% patients with none to mild pain. All the patients had infection control. Four patients needed a frame support for walking, while the remaining two were chairbound. Overall 83.3% patients expressed their satisfaction with the Girdlestone procedure. The Girdlestone operation appears as a viable solution to achieve pain relief and to control infection at the cost of limited mobility in this specific subgroup of patients with failed operative treatment for hip trauma.