gms | German Medical Science

Objectives: A devastating complication after total hip arthroplasty (THA) is periprosthetic joint infection (PJI). Most frequently spacers (Sp) with or without antibiotics are implanted in a two-stage procedure even though not always indicated due to unknown pathogen, femoral and acetabular defects or muscular insufficiency.

This study aims to analyze the general success rate when performing girdlestone procedure (GS) and the variation among age-groups as well as comparing the most common complications between GS procedure and Sp as described in the literature.

Methods: A retrospective analysis of a prospectively collected database was conducted, analyzing the treatment of 44 cases with chronic PJI undergoing GS surgery between January 2015 and December 2018. Diagnostics included intraoperative microbiological cultures, histological analysis, sonication of the initial implant, analysis of hip aspiration as well as laboratory diagnostics and blood cultures. We analyzed the general and age-group-specific success rate of treatment using GS. Furthermore, we compared our data with the current literature on spacer implantation regarding common complications.

Results and Conclusion: In total, 21 female and 23 male patients at a mean age of 59.3 (SD 9.6) years were included. Age groups where divided into young, mid-age and seniors. In most patients, microbiology revealed Staphylococcus epidermidis in 39.1% of cases, following Staphylococcus lugdunensis and Staphylococcus aureus in 10.9% after THA explantation. For histology, Krenn and Morawietz type 2 (infectious type) was diagnosed in 40.9%, type 3 (infectious and abrade induced type) in 25.0%. With GS, the total success rate was 84.1% compared to 87.6% using Sp as described in the literature. Among age-groups, success rate varied between 77.8% to 100%. Other complications, which only occurred the mid-age and senior age-group included the necessity of transfusion in 31.1% and in total one periprosthetic fracture was found (2.3%).

GS shows a high to equal general success rate in treatment of chronic PJI compared to Sp without major complications. For patients with indication for both treatments, GS seems to be a true alternative for chronic PJI when looking at the success rate of treatment.