Pelvic Support Osteotomy in the Treatment of Patients With Excision Arthroplasty

Abstract

Resistant hip infection in adults can be a complicated problem that does not respond to surgical and medical treatment. In such cases, the only remaining option is excision arthroplasty. This line of treatment can eradicate the infection but also is associated with poor function. In some cases, conversion of excision arthroplasty to artificial joint replacement is associated with too great a risk because of local hip surgical risks or low immunity with risk of recurrent infection. Pelvic support osteotomy with the Ilizarov modification can present an alternative solution for such patients. This study included 11 patients with resistant hip infection who were treated using excision arthroplasty. Pelvic support osteotomy then was used to improve hip stability and abductor muscle function. The Ilizarov modification was applied to correct mechanical alignment of the limb and the limb length discrepancy. Harris hip scores improved in all patients: the average score preoperatively was 43.5 (range, 31-50), whereas at final followup, the average score was 70.9 (range, 65-80). Pelvic support osteotomy, along with the Ilizarov modification, can provide an alternative treatment to improve function in patients previously managed with excision hip arthroplasty and Girdlestone surgery.

Pelvic Support Osteotomy With Ilizarov Method; Outcome of Pelvic Support Osteotomy With Ilizarov Method in Patients Undergoing Girdle Stone Procedure

“…The most common complications in pelvic support osteotomy is knee stiffness and pin tract infection. In our study pin tract infection occurs in patients which is comparable with Emara et al 12 Recuurent pin tract infection was treated by antibiotics. In our study knee stiffness occur in patients and mean loss of knee flexion was 20 Pelvic support osteotomy with Ilizarov Technique is a good option for patient undergoing girdle stone procedure.…”

“…The disadvantage of this procedure is delayed consolidation of bone, prolong duration and poor patient compliance. 12 Initially, the pelvic support osteotomy was introduced by Hass 15 for instability of hip joint. In early technique, hip stability was achieved with the help of support between the proximal femoral fragment and pelvis.…”

“…10,12,13 Considering all the above mentioned benefits, it was decided to conduct a study on pelvic support osteotomy to evaluate the outcome in our population, so that patients can be managed in a better way. The objective of the study was to evaluate the outcome of pelvic support osteotomy with Ilizarov method in patients undergoing girdle stone procedure in terms of pain relief and limb length discrepancy.…”

Clinical outcome following conversion of Girdlestone’s resection arthroplasty to total hip replacement

“…[1][2][3] However, numerous studies report poor functional outcomes, especially in the elderly. [4][5][6][7][8] Due to poor function and pain, some patients do not accept a RA as definitive treatment and request conversion of their RA to a THR, hoping to alleviate symptoms and enhance their quality of life.…”

Intramedullary femoral lengthening with an 'unstable' hip without prior stabilisation: preliminary results of a case series

“…5,6 All these reconstructive options alter the shape of the proximal femur and complicate future salvage surgery, such as a total hip replacement (THR). 7,8 Previous authors have described femoral lengthening without previous stabilisation of the hip with use of an external fixation system. 9 There are many theoretical benefits to the patient undergoing limb lengthening using an intramedullary device compared to an external fixator.…”