Results of the Girdlestone Procedure for the Treatment of Refractory Hip Prosthesis Infections.

INTRODUCTION

Refractory prosthetic joint infections (PJI) of the hip remain a major challenge in orthopedic surgery. The Girdlestone procedure, also known as resection arthroplasty, was originally described for native hips but has since been adopted as a salvage option for complex and recurrent prosthetic infections. The main objective of this study was to evaluate the effectiveness of this procedure in treating prosthetic hip infections in this context.

MATERIALS AND

METHODS

Eighty-eight patients (91 hips) who underwent femoral resection arthroplasty for refractory hip prosthesis infection between March 2004 and August 2019 were retrospectively included and analyzed as part of a single-center study with a minimum follow-up of two years. The primary outcome was infection eradication. Secondary outcomes included the incidence of treatment failure and the nature of postoperative complications. Risk factors for failure were identified using a Cox proportional hazards model. Bacteriological data and functional outcomes were also reported.

RESULTS

Out of 91 hips, infection eradication was achieved in 65 cases (71%) following Girdlestone procedure. Six postoperative deaths related to infection occurred (6/88, 7%). In 20 out of 91 hips (22%), one or more revision surgeries were performed for persistent infection after implant removal. Among these, infection control was achieved in 10/20 (50%). Multivariate analysis identified corticosteroid use (HR = 6; p < 0.01), preoperative fever (HR = 4.12; p < 0.01), and polymicrobial infection (HR = 2.5; p < 0.05) as independent risk factors for failure. The mean limb shortening was 5.7 (±1.7) cm, and the average walking distance was 175 (±350) meters. The mean Merle d'Aubigné and Postel score at final follow-up was 9.3 (±2.2) out of 18.

CONCLUSION

Definitive removal of the hip prosthesis remains a viable therapeutic option in refractory infections, despite a substantial complication rate. It should be considered, particularly when the prosthesis is no longer functional.

LEVEL OF EVIDENCE: IV; Retrospective case series.