Abstract
Nine cases of excision arthroplasties for infected hip replacements were reviewed at follow-ups of 1 to 13 years (mean 5.5) to assess the efficacy of this procedure. In 4 cases, the greater trochanter had been inserted into the acetabulum and the hips fixed by external fixators (coaptation arthroplasty), while the simple Girdlestone procedure had been performed in the other 5 cases. Clinical results consisting of JOA score, leg-length discrepancy, walking ability, patient's assessment of this procedure, assessment of muscle power and X-ray findings were compared between these two procedures.
Satisfactory pain relief was provided in 80% of the patients by the simple Girdlestone procedure and in 100% by the coaptation arthroplasty. In walking ability, the coaptation arthroplasty showed better results than the Girdlestone procedure (all patients needed walking aids) ; 2 needed two crutches in the Girdlestone group, 1 needed one crutch in the coaptation group and the others needed a single cane. Leg-length discrepancy was also less in the coaptation group (mean 3.9cm), and abduction of the hip was more limited. However, there was no significant difference in JOA score between the two groups, and all patients were satisfied with the excision arthroplasties. X-rays of the coaptation group after the removal of a cup-socket hip prosthesis showed a marked development of bony spikes in the acetabulum in 1 and the joint space-like finding was detected in 1.
It was concluded that the coaptation arthroplasty seems to be a better salvage procedure in the management of infected hip replacements than the simple Girdlestone procedure.
