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Hi all

Had a customer in today who had surgery, 7 years ago in Cyprus, to remove the femoral head and neck of the left hip joint. No new prosthesis was fitted and there is no bung between the femur and acetabulum as I have seen used before for short term use.

I have searched extensively for papers and info on this sort of surgery but can only find this procedure used in veterinary surgery and some mention of it being tried on humans in the early 20th century.

Unfortunately she also has recently (2 years ago) had a fracture of the right tibial condyle and this has resulted in a severely valgus knee position. (the surgery to repair the fractured joint was again done in cyprus):eek:

The lady walks with the aid of a stick in the right hand and places the right foot directly under her CoM to balance her weight, while swinging / dragging the left leg forward. The stick and left leg support during propulsion and swing of the right leg. The left is completely apropulsive and has a 40mm home made raise on the sole of her left sandal. Not a bad job actually, made from the soles of two flip flops glued together.

The result is she has a left leg that is functionally much shorter than the right and a right foot that is extremely everted (relative to the ground) in weightbearing due to the valgus knee and max supination of the STJ. This results in painful pressure trauma and callus build up on the medial r/foot.

The left hip 'joint' as it might be called is translated laterally since there is no bone to hold it in place and relies of ligament tension to stabilise it (I suppose) :eek:

The pelvis is rotated out of the usual planes of reference and the spine is scoliotic as a result. She wants to know if I can balance her up and get her walking better, which might be a bit of a task.

The real reason for writing is to ask if anyone has come across this type of surgery before and if so, what are the usual long term outcomes.

Regards Dave Smith

 

Sounds like you are referring to a Girdlestone procedure? It is amazingly common for failed THR revisions or recurrent dislocations. I will see at least 10 people per year with a Girdlestone. Outcomes vary - most end up pain free but with appauling shortening. THey are generally elderly and already have degenerative scolioses so determining the leg length discrepancy is a trial and error process in many cases.

The pdf below might help. As for helping with your actual patient, all I can say is good luck!

 

Robin

Thanks for your replyand the attached paper, searching Excision Arthroplasty gives more fruitful results and various text describe the resultant gait and posture that I have seen in my lady . Below is an excellent description from http://www.hipsurgery.co.il/english/exision.htm