Girdlestone procedure as a last salvage procedure in hip periprosthetic joint infections: when and how

INTRODUCTION: Recurrent or persistent prosthetic hip infection is one of the most serious complication in total hip replacement. Even if technological advancements and antibiotic therapy have significantly improved the treatment of failed total hip replacements, in some compromised patients reimplantations may be contraindicated. In these cases, Girdlestone procedure as salvage surgery can be considered a viable solution. The aim of this study is to summarize the indications for this type of surgery and remark expected results.EVIDENCE ACQUISITION: We performed in January 2021 a literature review using PubMed Electronic Databases. After excluding not relevant to Girdlestone Procedure for periprosthetic joint infection (PPJI) articles and collecting other papers found reading through their references, a total of 58 studies were analyzed. Furthermore, a quick description of this procedure is reported to highlight the differences between the originally excision described by Girdlestone and the most current methods of execution.EVIDENCE SYNTHESIS: Primary goal of Girdlestone excision arthroplasty is pain relief and infection control, but many other factors influence final outcome: leg length discrepancy, use of walking aid, contralateral hip arthrosis must be taken into account because of their impact on health status, quality of life and, overall, on patient satisfaction.CONCLUSIONS: We agree to the indications described in the literature: extremely severe bone defect unsuitable for prosthetic reconstruction, lack of soft tissue coverage, uncontrolled infection, medical contraindications to further sur-geries or a resolute refusal stated by the patient. We point out the importance of patient information, about the severe limb shortening expected (and its effect on walking ability), and the nature itself of this kind of surgery: a last salvage procedure.