International Orthopaedics

, Volume 36, Issue 5, pp 927–933 | Cite as

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

  • Ralf OheimEmail author
  • Justus Gille
  • Rita Schoop
  • Sonja Mägerlein
  • Cornelius H. Grimme
  • Christian Jürgens
  • Ulf-Joachim Gerlach
Original Paper



Hip-joint empyema is a severe local infection that can cause general illness and, in the worst-case scenario, death by septic complications. For severe hip-joint infections, the Girdlestone arthroplasty has been an established treatment option for many decades. We describe functional midterm results after treatment of haematological and postoperative hip-joint infections.


From 2000 to 2010, 24 patients underwent surgical treatment for 27 hip-joint empyemas. The surgical procedures included radical debridement, implantation of local antibiotic beads and soft tissue management. Besides clinical, laboratory and imaging parameters, we analysed the Harris hip score (HHS).


Twenty-three patients (26 hips) were followed up after a mean of 30 (3.1–126.8) months. The study group consists of 12 men and 11 women, with an average height of 1.71 m, weight of 84.7 kg and body mass index (BMI) of 28.6 kg/m2. Hip-joint empyema was due to haematological septic spread in eight patients, surgery related in 12 hips and other causes in six cases. One patient died due to septic complications during the hospital stay. Intraoperative bacterial culture was positive in 50%, with Staphylococcus aureus as the most common organism (n = 11). Average hospital stay was 35 days. HHS significantly improved from 18.2 preoperatively to 47.8 at follow-up. Functional results were mainly poor, but pain relief increased significantly. The infection control rate was 96% with four (15%) complications.


Resection arthroplasty by Girdlestone is able to control infection in most cases with an acceptable complication rate but poor functional results. In conclusion, the Girdlestone arthroplasty still is an essential surgical strategy for treating hip-joint empyema in cases in which functional outcome is of lesser priority.


Average Hospital Stay Prosthetic Replacement Open Reduction Internal Fixation Proximal Femoral Nail Osteosynthesis Material 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Sharma H, De Leeuw J, Rowley DI (2005) Girdlestone resection arthroplasty following failed surgical procedures. Int Orthop 29:92–95PubMedCrossRefGoogle Scholar
  2. 2.
    Castellanos J, Flores X, Llusa M, Chiriboga C, Navarro A (1998) The Girdlestone pseudarthrosis in the treatment of infected hip replacements. Int Orthop 22:178–181PubMedCrossRefGoogle Scholar
  3. 3.
    Pohlemann T, Stengel D, Tosounidis G, Reilmann H, Stuby F, Stockle U, Seekamp A, Schmal H, Thannheimer A, Holmenschlager F, Gansslen A, Rommens PM, Fuchs T, Baumgartel F, Marintschev I, Krischak G, Wunder S, Tscherne H, Culemann U (2011) Survival trends and predictors of mortality in severe pelvic trauma: Estimates from the German Pelvic Trauma Registry Initiative. InjuryGoogle Scholar
  4. 4.
    Ho GJ (2001) Bacterial arthritis. Curr Opin Rheumatol 13:310–314PubMedCrossRefGoogle Scholar
  5. 5.
    Esterhai JLJ, Gelb I (1991) Adult septic arthritis. Orthop Clin North Am 22:503–514PubMedGoogle Scholar
  6. 6.
    Girdlestone GR (2008) Acute pyogenic arthritis of the hip: an operation giving free access and effective drainage. 1943. Clin Orthop Relat Res 466:258–263PubMedCrossRefGoogle Scholar
  7. 7.
    Esenwein SA, Robert K, Kollig E, Ambacher T, Kutscha-Lissberg F, Muhr G (2001) Long-term results after resection arthroplasty according to Girdlestone for treatment of persisting infections of the hip joint. Chirurg 72:1336–1343PubMedCrossRefGoogle Scholar
  8. 8.
    Bourne RB, Hunter GA, Rorabeck CH, Macnab JJ (1984) A six-year follow-up of infected total hip replacements managed by Girdlestone's arthroplasty. J Bone Joint Surg Br 66:340–343PubMedGoogle Scholar
  9. 9.
    Clegg J (1977) The results of the pseudarthrosis after removal of an infected total hip prosthesis. J Bone Joint Surg Br 59:298–301PubMedGoogle Scholar
  10. 10.
    Kent M, Rachha R, Sood M (2010) A technique for the fabrication of a reinforced moulded articulating cement spacer in two-stage revision total hip arthroplasty. Int Orthop 34:949–953PubMedCrossRefGoogle Scholar
  11. 11.
    Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51:737–755PubMedGoogle Scholar
  12. 12.
    Haynes SR, Lawler PG (1995) An assessment of the consistency of ASA physical status classification allocation. Anaesthesia 50:195–199PubMedCrossRefGoogle Scholar
  13. 13.
    Mader JT, Shirtliff M, Calhoun JH (1999) The host and the skeletal infection: classification and pathogenesis of acute bacterial bone and joint sepsis. Baillieres Best Pract Res Clin Rheumatol 13:1–20PubMedCrossRefGoogle Scholar
  14. 14.
    Rittmeister ME, Manthei L, Hailer NP (2005) Prosthetic replacement in secondary Girdlestone arthroplasty has an unpredictable outcome. Int Orthop 29:145–148PubMedCrossRefGoogle Scholar
  15. 15.
    Choi HR, von Knoch F, Kandil AO, Zurakowski D, Moore S, Malchau H (2011) Retention treatment after periprosthetic total hip arthroplasty infection. Int Orthop 10.1007/s00264-011-1324-5
  16. 16.
    Bohler M, Salzer M (1991) Girdlestone's modified resection arthroplasty. Orthopedics 14:661–666PubMedGoogle Scholar
  17. 17.
    Grauer JD, Amstutz HC, O'Carroll PF, Dorey FJ (1989) Resection arthroplasty of the hip. J Bone Joint Surg Am 71:669–678PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Ralf Oheim
    • 1
    Email author
  • Justus Gille
    • 1
  • Rita Schoop
    • 1
  • Sonja Mägerlein
    • 1
  • Cornelius H. Grimme
    • 1
  • Christian Jürgens
    • 1
  • Ulf-Joachim Gerlach
    • 1
  1. 1.BG Trauma Hospital Hamburg, Septic Bone and Joint SurgeryHamburgGermany

Personalised recommendations