Girdlestone’s arthroplasty is often used to treat septic loosening of hip prostheses. Although this operation provides goodresults with regards to pain and loosening, it causes instability and in the hip and limb shortening that force the patient to use walking aids.

From 1990 to 1999 we treated ten cases of revisionhip arthroplasty after Girdlestone’s arthroplasty. Girdleston e’sarthroplasty was carried out in all cases due to sepsis in the previousimplant. Preoperatively all patients underwent granulocyte-labeledscintigraphy. For clinical evaluation we used the Merle D’Aubignè score.

From 1990 to 1999 we treated ten cases of revisionhip arthroplasty after Girdlestone’s arthroplasty. Girdleston e’sarthroplasty was carried out in all cases due to sepsis in the previousimplant. Preoperatively all patients underwent granulocyte-labeledscintigraphy. For clinical evaluation we used the Merle D’Aubignè score.

Girdlestone’s arthroplasty is very effective for treating septic loosening of hip prostheses, but it causes severe walking impediment. Revision surgery restores limb length and walking. Patients that undergo this treatment should be checked for residual sepsis, which may jeopardize the operation. Currently we are experimenting with spacers with antibiotics and our initial results are promising.

Introduction Total hip arthroplasty in patients affected by major dysplasia poses great surgical difficulties due to insufficient primary acetabulum, small femoral canal, excessive anteversion of the femoral neck, traction on the neurovascular structures, muscular imbalance that is difficult to restore, and marked epiphyseal rising. In this study we present our experience in lowering and arthroplasty in major hip dysplasia, obtained by shortening osteotomy achieved in a single stage, using techniques designed to diminish possible risks.

Materials and methods From 1989 to 2000 we treated 20 patients (27 operations, 7 bilateral) at our institute who were affected by the sequela (lowering of the prosthesis) of Eftekhar Grade-C (11 cases) or Grade-D (16 cases) congenital luxation of the hip. Mean follow-up was 63 months. Clinical results were assessed before and after surgery according to the Merle D’Aubigné method. We also evaluated the presence and degree of Trendelenburg position and the possible use of shoe lifts. The radiographic results of the hip prosthesis were assessed by the Gruen and Dee Lee methods for the stem and cup respectively.

Results The mean preoperative clinical score according to the Merle D’Aubigné classification was 3 ± 1 for pain, 3 ± 1 for walking, and 4 ± 2 for movement. The preoperative Trendelemburg position was very marked in all patients. In 18 cases out of 27 a shoe lift was used with a mean height of 60 mm ± 10. We performed a “Z” osteotomy in 14 cases and an oblique osteotomy in 13 cases. The postoperative mean clinical score was 6 ± 1 for pain, 6 ± 1 for walking, and 5 ± 1 for movement. Postoperative Trendelemburg position was present in 19 cases, and 9 cases out of 27 still used a shoe lift with a mean height of 30 mm ± 10. Movement of the cup and stem was observed at 84 months and 112 months’ follow-up respectively, which required revision surgery.

Conclusions The choice between oblique and Z osteotomy depends on two parameters: the surgeon’s experience and the extent of femoral resection. Z osteotomy may be more difficult to perform technically, but it enables better adaptation of the prosthesis to the femoral segments for resections over 35 mm. No significant differences in time to unite were observed between oblique and Z osteotomies.

Introduction: Replacing a fused or ankylosed hip with a prosthesis has several advantages. It reduces the pain in the lumbar-sacral spine and the ipsilateral knee. It gives a better range of movement and leg length is restored.

Methods: In this study we present our experience of 50 cases of total hip arthroplasty in fused or ankylosed hips. Aetiopathogenesis was rhizomelic spondylitis in 35 cases, sequelae of coxitis in 2, posttraumatic in 4, Ankylosis in 6, and fusion in 3. For clinical assessment we used the Merle D’Aubignè score, and for radiographic evaluation we used the Gruen method of area subdivision.

Results: Of the 50 prosthesis implanted, 3 were removed due to aseptic loosening. The other were radiographically stable after an average follow-up of 12 years. Preoperative clinical scores were: pain (2.9), range of motion (2.5), and walking (2.1). At the latest exam the scores were: pain (5.5), motion (4.6), walking (4.5). Preoperative leg shortening was 3.5 cm, whereas at the latest exam it was 0.9 cm. Lumbalgia decreased notably in 62%.

Conclusions: Total hip arthroplasty may have advantages over fusion on one hand, but on the other it is technically more difficult and gives results that are inferior to common indications. It is therefore important to assess patients (time of fusion, age of patient, residual muscular function) preoperatively to obtain good results