Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca

Kazuistika / Case report

ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE ČECHOSL.,
75, 2008, p. 306 - 307

Extensive Subtrochanteric Shortening Osteotomy Enables the Conversion of a Long Lasting Resection Arthroplasty to a Total Hip Replacement

Subtrochanterická osteotomie s velkým zkratem umožňuje konverzi resekční artroplastiky na TEP kyčelního kloubu po delší době

S. KESSLER

Ortopedie Department, Sindelfingen District Hospital, Sindelfingen, Germany

SUMMARY

This case report presents the results of a conversion hip arthroplasty after a long lasting Girdlestone situation of 15 yaers in combination with an extensive shortening of the leg of 7.2 centimeters. An extensive subtrochanteric shortening osteotomy of 3.5 centimeters was necessary to restore leg length and the rotational centre of the hip.

Functional outcome was excellent within the long run and a restoration of the independence of the patient was achieved.

INTRODUCTION

Resektion arthroplasty of the hip joint according to Girdlestone is a surgical procedure which is predominantly performed to treat septic arthritis of the hip joint or infected total hip replacements (8). However persisting resection arthroplasty results in a considerable alteration of hip function with instability and increasing shortening of the extremity, which often makes orthe-tics necessary (3,7). Furthermore patients complain of persisting pain restricting several shapes of their lives. Especially younger patients do not accept this situation as the definite outcome. Conversion to a total hip replacement is desired (2,8).

DESCRIPTION OF THE RESPECTIVE CASE

A 37-year old man presented with a long lasting Girdlestone situation of his left hip which was performed 15 years ago because of recurrent septic coxitis (figure 1). He asked for conversion to a total hip replacement because of constant moderate pain and unacceptable restriction in daily activities. He was mobilised with one French crutch and a shoe elevation. On physical examination we found a shortening of the affected extremity of 7.2 centimetres. After critical consenting of the patient, the operation was performed under maximal relaxation in general anesthesia. Apart from an extensive debridement, a complete muscle release (with the exception of the insertion of the gluteus medius muscle and the psoas tendon) in combination with an extensive subtrochanteric shortening osteotomy of 3.5 centimeters was necessary to restore the leg length and the rotational centre of the hip. A revision stem implant was used, which provides rotational stability by longitudinal ribs and anchors methaphyseal and diaphyseal (figure 2).

Postoperatively no weight-bearing for six weeks and for further four weeks only partial weight-bearing with 30 kilograms was allowed. The osteotomy united within 6 months. 1.5-years after operation the man finally presented in outpatient clinic. He reported to be completely pain free and mobilised without any support (figure 3). Meanwhile he was engaged and plans to establish a family were on their way.

DISCUSSION

Conversion of a Girdlestone situation into a total hip replacement is a demanding surgical procedure (1). Difficulties and complications can arise depending on the duration of resection arthroplasty and the degree of shortening. However, when surgery is successful, patients' satisfaction and hip function is high (4,5,6).

In this case, shortening of more than 7 centimetres in combination with a long lasting resection arthroplasty 15 years ago made the decision to converse into a hip arthroplasty critical. Only extensive subtrochanteric shortening osteotomy and muscle release allowed anatomical implantation of the prosthesis ending up in excellent functional results and a restoration of independence of the patient.

References

1. BERMAN, A. T., MAZUR, D.: Conversion of resection arthroplasty to total hip replacement. Orthopaedics, 17:1155-1158, 1994.
2. GOLDA, W., PAWELEC, A., WALCZAK, J.: Clinical results evaluation of the Girdlestone's procedure after hip arthrography. Ortop Traumatol. Rehabil., 30:68-70, 2001.
3. HUDEC, T., JAHODA, D., SOSNA, A.: Resection hip arthroplasty - mid and long-term results. Acta Chir. orthop., Traum. Čech, 72:287-92, 2005.
4. RITTMEISTER, M., MULLER, M., STARKER, M., HAILER, N. R: Functional results following Girdelstone arthroplasty. Z. Orthop., 141:665-71, 2003.
5. RITTMEISTER, M., MANTHEI, L., MULLER, M., HAILER, N. R: Reimplantation of the artificial hip joint in girdlestone hips is superior to girdlestone arthroplasty by itself. Z. Orthop., 142:559-563, 2004.
6. RITTMEISTER, M. E., MANTHEI, L, HAILER, N P.: Prosthetic replacement in secondary Girdlestone arthroplasty has an unpredictable outcome. Int. Orthop., 29:145-148, 2005.
7. STAUNER, K.,HONLE, W., SCHUH, A.: Long-term results of salvage procedures following intrapelvic migration of loosened total hip arthroplasties. Zbl. Chir., 132:146-150, 2007.
8. STO KLAS, J., ROZKYDAL, Z.: Resection of the head and neck of the femoral bone according to Girdlestone. Acta Chir. orthop., Traum. Čech., 71:147-151, 2004.

Práce byla přijata 20. 5. 2008.