Girdlestone Procedure for Infected Joint Replacement

What is the Girdlestone Procedure for Infected Joint Replacement?

The Girdlestone procedure, also known as a femoral head ostectomy, excision arthroplasty, or resection arthroplasty, is a surgical procedure used primarily as a salvage operation for infected hip joint replacements. It involves the removal of the femoral head and neck, leaving the patient without a hip joint. Due to the damage, the surgeon is unable to implant any prosthetic devices into the joint. The patient may go weeks or months without a hip joint, or it could be permanent. This procedure can eliminate infection and relieve pain but results in a shorter leg and reduced mobility.

Indications for Girdlestone Procedure

Girdlestone procedure is typically used as a salvage or last resort procedure in many cases, such as:

• Persistent or recurrent infection of a hip prosthesis that does not respond to antibiotic therapy or surgical debridement.
• Significant bone loss or damage that makes it difficult or impossible to secure a new prosthesis.
• Chronic instability and recurrent dislocation of the hip prosthesis, which may also be associated with infection.
• Patients who are not suitable candidates for more extensive or complex revision surgeries due to poor overall health or comorbid conditions.

Preparation for Girdlestone Procedure for Injected Joint Replacement

In general, preparation for the Girdlestone procedure may involve the following:

• A comprehensive medical evaluation, including a review of your medical history, medications, and allergies to assess your overall health and suitability for the surgery.
• Blood tests, joint fluid analysis, and imaging studies (X-rays, MRI, or CT scans) to determine the extent of the infection and plan the surgery.
• Adjusting or stopping medications that may affect surgery, such as blood thinners.
• Instructions on fasting before surgery, stopping smoking, and limiting alcohol consumption.
• Obtaining an informed consent form after a detailed explanation of the procedure, its risks, benefits, and postoperative expectations.

Procedure for Girdlestone Procedure for Injected Joint Replacement

In general, the Girdlestone procedure for infected joint replacement may involve the following steps:

• The patient is given either general anesthesia (to put them to sleep) or regional anesthesia (spinal or epidural) to numb the lower half of the body.
• The surgeon makes an incision over the hip to access the joint. The exact location and length of the incision depend on the previous surgeries and the extent of infection.
• The infected prosthetic joint is carefully removed. This includes taking out all components of the hip replacement (femoral and acetabular parts).
• Thorough debridement is performed to remove all infected and necrotic tissue, including bone and soft tissue.
• In some cases, antibiotic-impregnated spacers may be placed in the joint space to deliver high concentrations of antibiotics directly to the infected area and maintain some joint space.
• Often, the joint space is left empty, allowing the body to form a fibrous tissue matrix in the area.
• The surgical wound is closed in layers. Drains may be placed to help remove excess fluid and prevent hematoma (collection of blood) formation.
• The skin is sutured or stapled closed, and a sterile dressing is applied.

Postoperative Care and Recovery

In general, postoperative care and recovery from the Girdlestone procedure for infected joint replacement may involve the following:

• The patient is moved to the recovery room to be monitored as they wake up from anesthesia.
• Pain is managed with medications, and antibiotics are continued to ensure the infection is controlled.
• Surgical drains, if placed, are typically removed a few days after surgery once drainage decreases.
• Rehabilitation starts early to maintain as much mobility as possible and to strengthen the muscles around the hip.
• Patients may need crutches, a walker, or a wheelchair initially, progressing to less assistance as they recover.
• Regular follow-up appointments will be scheduled to monitor for signs of infection recurrence and to assess the healing process.

Risks and Complications

Risks and complications associated with the Girdlestone procedure for injected joint replacement may include:

• Infection recurrence
• Reduced mobility
• Chronic pain
• Leg length discrepancy
• Bleeding
• Blood clots
• Anesthesia-related complications 

Summary

The Girdlestone procedure is generally seen as a last resort when other surgical options are not viable or have been exhausted. It is a salvage procedure aimed at controlling infection, relieving pain, and improving quality of life, although at the cost of significant loss of hip function and leg length discrepancy. The decision to proceed with a Girdlestone procedure should involve a thorough discussion with the patient regarding the expected outcomes, potential complications, and the impact on mobility and lifestyle.