DOI: https://doi.org/10.

53350/pjmhs22161195
CASE REPORT

Girdle Stone Procedure in bilateral Rheumatoid Hip: A Case Report

IJAZ AMIN1, TALHA ABDUL MOEED 2, WAJIDA PERVEEN1*, MUHAMMAD AKHTAR3, UMER ILYAS4, SHOAIB JAVAID2
1
Department of Physiotherapy, Sialkot College of Physical Therapy, Sialkot-Pakistan
2
Department of Orthopedic Surgery, Mayo Hospital, Lahore-Pakistan
3
Department of Physiotherapy, UOL, Lahore-Pakistan
4
Department of Physiotherapy, PSRD College of Rehabilitation Sciences, Lahore-Pakistan
Correspondence to Dr. Wajida Perveen, Email: [email protected] Tel:+92-333-3507157.

SUMMARY
Rheumatoid arthritis is multisystem disease affecting synovial joints at most. Females are the largest victims. Usually it affects
the peripheral joints but weight bearing joints are also not spared. Rheumatoid hip is one of the presentations. Here we present a
case of young girl with bilateral rheumatoid hip. She was having bilateral avascular necrosis of femoral heads rendering her
crippled to perform activities of daily living along with severe pain. Girdle stone procedure was performed followed by
physiotherapy. She progressed well and was able to walk with stick and perform ADL’s with ease.
Keywords: Rheumatoid hip, girdle stone procedure, hip arthroplasty, avascular necrosis, lower extremity function scale,

INTRODUCTION clearly briefed about outcomes, potential risks and benefits of the
1
procedure. Base line Pre-Operative investigations were carried out
Hip joint disease affects 30-40% of patients with RA . Total hip and surgery was performed under spinal anesthesia. Wounds were
arthroplasty has revolutionized the treatment of patients with failed stitched over tube drain; soft tissues were repositioned and
operative treatment for hip trauma. However, medically unfit for attached. Bilateral POP de-rotation boots were applied for four
arthroplasty and functionally compromised patients, who have a weeks. Bilateral skeletal traction was applied with proximal tibial
high anesthetic and operative risk, may not be convenient for any pins. Drain was removed after 48 hours and patient was
further major interventions. In such cases, the Girdle stone discharged. Home programme including elevation at 45° hip flexion
resection arthroplasty (pseudoarthosis coxae) is preferred as an with 10Kg weight traction on each side for four weeks, was
procedure of choice2. In non-ambulatory patients with no advised.
probability of reimplantation, Girdle stone procedure is one of the
options for treating an infected hip arthroplasty3. The Girdle stone
RESULTS
procedure seems to be effective in controlling infection and
relieving pain which is a common complaint after failure of Physiotherapy was started after six weeks of surgery, including
surgeries for hip fractures. In surviving group of patients, the Range of motion exercises and exercises to improve the muscles
satisfaction rate was appreciable probably because of their limited tone acting on hip was started initially for six weeks and after
functional demands despite of a high mortality rate and poor reassessment for four more weeks. Along with periodic
functional outcome2. assessments, major follow up was done after two years. She was
Girdle stone procedure (GSP) is a salvage procedure and its able to walk initially with a walking frame and later on with a stick.
indications to perform it have significantly been modified over time4 There was no Leg length discrepancy found. Values of outcome
however it can be considered at young age to prevent functional measurement scales LEFS & HHS are expressed as table 1.
limitations, avoid pain and improve quality of gait5. In a study Difference between pre and post op values were found significant
conducted in Germany by F Hefti, it was suggested that in juvenile (P=0.000)
RA, if hip is involved GSP may be considered prior to hip
arthroplasty6. Here we present a rare case of juvenile RA with Figure-1: X-Ray Pelvis before Surgery
bilateral infected hip joints and avascular necrosis which was
treated with girdle stone procedure.

METHODOLOGY
A young female (adolescent) presented to orthopedic OPD with
complaints of pain, dysfunction and restriction of movements at
both hip joints leading to inability in performance of activities of
daily living (ADL’s). She was a known case of “Juvenile
Rheumatoid Arthritis”. On radiological examination her both hips
were having avascular necrosis (AVN) of femoral head. On
Physical examination her lower extremity function score (LEFS)
was 14/80 in right and 14/80 in left, Hip Haris Score (HHS) was
Figure-2: X-Ray Pelvis after Surgery
17/100 on right and 17/100 on left side. LEFS is a 20 item
questionnaire evaluating persons’ daily activities. LEFS score
ranges from 0-80 and 9 point change is considered as clinically
minimal important difference and minimal detectable change
value7. While HHS consist of ten items with 4 domains measuring
pain, function, absence of deformity and range of motion8. Its
highest score is 100 and less than 70 is considered poor.
She belonged to poor socioeconomic status and her parents
were not able to afford any expensive surgical procedure and long
follow ups. With the consent of parents, orthopedic surgeon
decided to opt for girdle stone procedure for both hips. They were
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Received on 24-07-2021
Accepted on 13-12-2021

P J M H S Vol. 16, No.01, JAN 2022 195

GSP in bilateral Rheumatoid Patients

Table-1: Values of outcome measurement scales LEFS & HHS complications reported included deep vein thrombosis, re-infection
Parameters Right Hip Left Hip P value and anemia1 but our patient was safe of these major complications.
HHS (before GSP) 17/100 17/100 0.000*
HHS (after GSP) 72/100 72/100
LEFS (before GSP) 14/80 14/80
CONCLUSION
LEFS (after GSP) 14/80 14/80 0.000* It was concluded that although GSP is a salvage procedure, but
*Statistically significant may be considered in cases when surgeon have limited choices in
terms of follow up and cost of surgery.
DISCUSSION Author’s contribution: IA&TAM: Conception & design of study,
UI & SJ: Data collection & Analysis, MA&WP: Drafting and
In this study bilateral girdle stone procedure was performed on
revisions of manuscript.
young female with history of rheumatoid hip. The outcomes were
Conflict of interest: None
satisfactory in improving LEFS and HHS.
Funding: None
A study reported the result of 78 resections of the head and
neck of femur (girdle pseudoarthosis) in patient with infected hips.
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