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Modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov external fixator as a salvage method in the management of severely infected total hip replacement.

Kliushin NM, Ababkov YV, Ermakov AM, Malkova TA - Indian J Orthop (2016 Jan-Feb)

Bottom Line: The Harris hip score ranged from 35 to 92 points.Hip joint motion ranged from 10° to 30° in the modified arthroplasty group.No subluxation or LLD progression was observed.

View Article: PubMed Central - PubMed

Affiliation: Bone Infection Clinic, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan 640014, Russian Federation, Russia.

ABSTRACT

Background: Resection arthroplasty or hip arthrodesis after total hip replacement (THR) can be used to salvage the limb in case with deep infection and severe bone loss. The Ilizarov fixator provides stability, axial correction, weight-bearing and good fusion rates.

Materials and methods: We retrospectively assessed the outcomes of 37 patients with severe periprosthetic infection after THR treated between 1999 and 2011. The treatment included implant removal, debridement and a modified Girdestone arthroplasty (29 cases) or hip arthrodesis (seven cases) using the Ilizarov fixator. The Ilizarov fixation continued from 45 to 50 days in the modified arthroplasty group and 90 days in the arthrodesis group. One case was treated using the conventional resection arthroplasty bilaterally.

Results: Eighteen months after treatment, infection control was seen in 97.3% cases. Six hips were fused as one patient died in this group. Limb length discrepancy (LLD) averaged 5.5 cm. The Harris hip score ranged from 35 to 92 points. Hip joint motion ranged from 10° to 30° in the modified arthroplasty group. All subjects could walk independently or using support aids. No subluxation or LLD progression was observed.

Conclusion: The modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov apparatus results in sufficient ability for ambulation and good infection control in cases of failed THR associated with severe infection.

No MeSH data available.


Related in: MedlinePlus

Schematic diagram showing the location of half-pins and wires for fixation and placement of draining systems
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Figure 3: Schematic diagram showing the location of half-pins and wires for fixation and placement of draining systems

Mentions: The mounting of the Ilizarov apparatus started with the insertion of five half-pins into the iliac wing that were attached to an Ilizarov hip arch [Figure 3]. Next, two wires were drilled into the middle third of the femur and three wires into its lower third. The wires were fastened on the middle and distal apparatus rings. Temporary sutures and gauze pieces were taken off to open the joint. The proximal end of the femur was refreshed and inserted into the acetabulum, or to its upper edge in case of an interior acetabular defect. The femur was positioned functionally (10°–20° of abduction from the middle line in both groups, flexion from 10° to 20° in the arthrodesis group). The external arch and the rings were connected with threaded rods and hinges. The maximum contacting surface between the proximal femur end and the acetabular bottom was achieved by adjusting the rods and hinges [Figure 1b]. Grafting was not used for fusion.


Modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov external fixator as a salvage method in the management of severely infected total hip replacement.

Kliushin NM, Ababkov YV, Ermakov AM, Malkova TA - Indian J Orthop (2016 Jan-Feb)

Schematic diagram showing the location of half-pins and wires for fixation and placement of draining systems
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4759869&req=5

Figure 3: Schematic diagram showing the location of half-pins and wires for fixation and placement of draining systems
Mentions: The mounting of the Ilizarov apparatus started with the insertion of five half-pins into the iliac wing that were attached to an Ilizarov hip arch [Figure 3]. Next, two wires were drilled into the middle third of the femur and three wires into its lower third. The wires were fastened on the middle and distal apparatus rings. Temporary sutures and gauze pieces were taken off to open the joint. The proximal end of the femur was refreshed and inserted into the acetabulum, or to its upper edge in case of an interior acetabular defect. The femur was positioned functionally (10°–20° of abduction from the middle line in both groups, flexion from 10° to 20° in the arthrodesis group). The external arch and the rings were connected with threaded rods and hinges. The maximum contacting surface between the proximal femur end and the acetabular bottom was achieved by adjusting the rods and hinges [Figure 1b]. Grafting was not used for fusion.

Bottom Line: The Harris hip score ranged from 35 to 92 points.Hip joint motion ranged from 10° to 30° in the modified arthroplasty group.No subluxation or LLD progression was observed.

View Article: PubMed Central - PubMed

Affiliation: Bone Infection Clinic, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan 640014, Russian Federation, Russia.

ABSTRACT

Background: Resection arthroplasty or hip arthrodesis after total hip replacement (THR) can be used to salvage the limb in case with deep infection and severe bone loss. The Ilizarov fixator provides stability, axial correction, weight-bearing and good fusion rates.

Materials and methods: We retrospectively assessed the outcomes of 37 patients with severe periprosthetic infection after THR treated between 1999 and 2011. The treatment included implant removal, debridement and a modified Girdestone arthroplasty (29 cases) or hip arthrodesis (seven cases) using the Ilizarov fixator. The Ilizarov fixation continued from 45 to 50 days in the modified arthroplasty group and 90 days in the arthrodesis group. One case was treated using the conventional resection arthroplasty bilaterally.

Results: Eighteen months after treatment, infection control was seen in 97.3% cases. Six hips were fused as one patient died in this group. Limb length discrepancy (LLD) averaged 5.5 cm. The Harris hip score ranged from 35 to 92 points. Hip joint motion ranged from 10° to 30° in the modified arthroplasty group. All subjects could walk independently or using support aids. No subluxation or LLD progression was observed.

Conclusion: The modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov apparatus results in sufficient ability for ambulation and good infection control in cases of failed THR associated with severe infection.

No MeSH data available.


Related in: MedlinePlus