Girdlestone resection arthroplasty following failed surgical procedures

Sharma, Himanshu; Leeuw, Jan De; Rowley, D.I.

doi:10.1007/s00264-004-0633-3

Cited by 76 publications

(60 citation statements)

References 12 publications

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“…A Girdlestone situation might also be an alternative for this patient group, especially with poor bone stock. This will, however, leave the patient with quite poor function 92,93 , and is probably best reserved for the older patients with very low demand on their hip 94 .…”

Section: Salvage After Failed Treatmentmentioning

confidence: 99%

Acetabular fracture assessment in four different pelvic trauma centers: have the Judet views become superfluous?

Clarke-Jenssen

Øvre

Røise

et al. 2015

Arch Orthop Trauma Surg

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Section: Salvage After Failed Treatmentmentioning

confidence: 99%

Acetabular fracture assessment in four different pelvic trauma centers: have the Judet views become superfluous?

Clarke-Jenssen

Øvre

Røise

et al. 2015

Arch Orthop Trauma Surg

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“…35 This salvage technique is seen as acceptable for patients who are not fit for further revision operations because of poor bone stock or a high risk of recurring infection. 36 Other indications include poor quality of soft tissue, infection with multiple or resistant organisms, poor general health or high complexity of reconstruction arthroplasty. 37 The main purpose of the Girdlestone procedure is to reduce pain, as overall quality of life and patient satisfaction may not be improved because of substantially worse functional outcomes.…”

Section: Permanent Resectionmentioning

confidence: 99%

“…37 The main purpose of the Girdlestone procedure is to reduce pain, as overall quality of life and patient satisfaction may not be improved because of substantially worse functional outcomes. 19,35,36 Patients are often left with a stiff joint and limited mobility, limb shortening as a result of bone loss and scar tissue, and a requirement for a walking aid. 37 Impact on patients and costs to health services Deep SSIs are associated with substantial costs.…”

Section: Permanent Resectionmentioning

confidence: 99%

A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

Graves

Wloch

Wilson

et al. 2016

Health Technol Assess

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BackgroundA deep infection of the surgical site is reported in 0.7% of all cases of total hip arthroplasty (THA). This often leads to revision surgery that is invasive, painful and costly. A range of strategies is employed in NHS hospitals to reduce risk, yet no economic analysis has been undertaken to compare the value for money of competing prevention strategies.ObjectivesTo compare the costs and health benefits of strategies that reduce the risk of deep infection following THA in NHS hospitals. To make recommendations to decision-makers about the cost-effectiveness of the alternatives.DesignThe study comprised a systematic review and cost-effectiveness decision analysis.Setting77,321 patients who had a primary hip arthroplasty in NHS hospitals in 2012.InterventionsNine different treatment strategies including antibiotic prophylaxis, antibiotic-impregnated cement and ventilation systems used in the operating theatre.Main outcome measuresChange in the number of deep infections, change in the total costs and change in the total health benefits in quality-adjusted life-years (QALYs).Data sourcesLiterature searches using MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials were undertaken to cover the period 1966–2012 to identify infection prevention strategies. Relevant journals, conference proceedings and bibliographies of retrieved papers were hand-searched. Orthopaedic surgeons and infection prevention experts were also consulted.Review methodsEnglish-language papers only. The selection of evidence was by two independent reviewers. Studies were included if they were interventions that reported THA-related deep surgical site infection (SSI) as an outcome. Mixed-treatment comparisons were made to produce estimates of the relative effects of competing infection control strategies.ResultsTwelve studies, six randomised controlled trials and six observational studies, involving 123,788 total hip replacements (THRs) and nine infection control strategies, were identified. The quality of the evidence was judged against four categories developed by the National Institute for Health and Care ExcellenceMethods for Development of NICE Public Health Guidance(http://publications.nice.org.uk/methods-for-the-development-of-nice-public-health-guidance-third-edition-pmg4), accessed March 2012. All evidence was found to fit the two highest categories of 1 and 2. Nine competing infection control interventions [treatments (Ts) 1–9] were used in a cohort simulation model of 77,321 patients who had a primary THR in 2012. Predictions were made for cases of deep infection and total costs, and QALY outcomes. Compared with a baseline of T1 (no systemic antibiotics, plain cement and conventional ventilation) all other treatment strategies reduced risk. T6 was the most effective (systemic antibiotics, antibiotic-impregnated cement and conventional ventilation) and prevented a further 1481 cases of deep infection, and led to the largest annual cost savings and the greatest gains to QALYs. The additional uses of laminar airflow and body exhaust suits indicate higher costs and worse health outcomes.ConclusionsT6 is an optimal strategy for reducing the risk of SSI following THA. The other strategies that are commonly used among NHS hospitals lead to higher cost and worse QALY outcomes. Policy-makers, therefore, have an opportunity to save resources and improve health outcomes. The effects of laminar air flow and body exhaust suits might be further studied if policy-makers are to consider disinvesting in these technologies.LimitationsA wide range of evidence sources was synthesised and there is large uncertainty in the conclusions.FundingThe National Institute for Health Research Health Technology Assessment programme and the Queensland Health Quality Improvement and Enhancement Programme (grant number 2008001769).

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“…The mortality rate is reported to be between 7% and 62% [1,2]. Clinical aspects vary from mild pain without signs of local infection to general septic disease.…”

Section: Introductionmentioning

confidence: 99%

“…In the past two decades, the procedure gained a new reputation as a salvage procedure for failed hip replacement [1,2]. There have been several publications about Girdlestone arthroplasties following failed hip replacement [2,[7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Surgical therapy of hip-joint empyema. Is the Girdlestone arthroplasty still up to date?

Oheim

Gille

Schoop

et al. 2011

International Orthopaedics (SICOT)

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Girdlestone resection arthroplasty following failed surgical procedures

Abstract: We retrospectively reviewed 43

Cited by 76 publications

References 12 publications

Acetabular fracture assessment in four different pelvic trauma centers: have the Judet views become superfluous?

Acetabular fracture assessment in four different pelvic trauma centers: have the Judet views become superfluous?

A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

Surgical therapy of hip-joint empyema. Is the Girdlestone arthroplasty still up to date?

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