Girdlestone operation

Girdlestone hip after removal of an infected endoprosthesis

The Girdlestone operation is a surgical procedure in orthopedics and trauma surgery in which the femoral head is resected . Such a Girdlestone hip is also created by removing an infected endoprosthesis (initially) without replacement .

history

The resection of the femoral head to treat the severe destruction of the femoral head and / or acetabulum , for example through femoral head necrosis , purulent coxitis or destructive coxarthrosis , was proposed in the 1940s by the English orthopedic surgeon Gathorne Robert Girdlestone (1881-1950) and named after him .

indication

Due to the development of modern endoprosthetics , the indication for Girdlestone surgery has only been made exceptionally since the second half of the 20th century. Only in the case of severe, purulent inflammation of the hip joint, the implantation of a prosthesis must primarily be dispensed with; in these cases, a Girdlestone situation is created for the time being and prosthetic treatment is sought after the infection has healed.

The Girdlestone plastic is more often used in the treatment of septic complications after the implantation of a hip joint endoprosthesis: Here the artificial joint is removed, the Girdlestone situation is left until the infection has calmed down and then - if possible - a new prosthesis is sought.

surgery

The hip joint is found through a longitudinal incision on the side and the joint capsule is removed. The femoral neck is set down with the oscillating saw and the femoral head removed. The pan, which is usually badly damaged in these cases, is milled out. All infected or necrotic tissue is removed; to clean up the infection, ball chains containing gentamicin are inserted, if necessary, which release their antibiotic active ingredient in high concentrations to the surrounding tissue over a longer period of time. In the first few days, blood and wound secretions are sucked off via Redon drains .

See also : femoral head resection

Aftercare

A partial load on the affected leg is only possible several weeks after the operation, when stable scar tissue has formed in the hip socket and around the upper end of the femur. The physiotherapy therefore first mobilization is under relief. The adjustment of the femoral stump to the upper edge of the socket or to the hip socket can be promoted by prescribing appropriate orthotics . The shortened leg length is compensated for by an increased heel. After healing, walking for short distances with forearm crutches is almost painless.

A Dutch working group reported that 37% of the treated patients were able to walk without or with only one crutch, 63% required two crutches; none of the patients had problems sitting.

literature

• Gathorne Robert Girdlestone: Arthrodesis and other operations for tuberculosis of the hip . The Robert Jones Birthday Vol., Oxford University Press, London 1928, p. 347.
• Gathorne Robert Girdlestone: Acute pyogenic arthritis of the hip . The Lancet 1 (1943), pp. 419-421.

Web links

• Gathorne Robert Girdlestone (Eng. WP)

Individual evidence

1. ↑ Peter Reuter: Springer Lexicon Medicine. Springer, Berlin a. a. 2004, ISBN 3-540-20412-1 , p. 791.
2. ↑ John Callaghan, Aaron G. Rosenberg, Harry E. Rubash: The Adult Hip . tape 1 . Lippincott Williams & Willki, 2006, ISBN 0-7817-5092-X , pp. 756 ff . ( here online ).
3. ↑ Michiel Mulier, Jos Stuyck: Girdlestone Resection Arthroplasty of the Hip . In: GHIM Walenkamp (Ed.): Local Antibiotics in Arthroplasty: State of the Art from an Interdisciplinary Point of View . Thieme, Stuttgart 2007, ISBN 1-58890-607-8 , p. 157 ( online here ).

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