Total hip arthroplasty after seven decades of a Girdlestone situation due to tuberculous coxitis in childhood

INTRODUCTION: Tuberculous coxitis accounts for about 15% of all osteoarticular tuberculosis cases and is the second most common after spinal tuberculosis. In extensive cases, Girdlestone resection arthroplasty is an option for primary surgical treatment followed in the course of time, with total hip arthroplasty (THR) to increase function. However, the remaining bone stock is generally poor. In these cases, the Wagner cone stem offers good pre-conditions for bone restoration even seven decades after Girdlestone, as presented here. CASE REPORT: A 76-year-old male patient was admitted to our department with a painful hip, who had previously been treated with Girdlestone at the age of 5 years after being diagnosed with tuberculous coxitis. After an intensive and very detailed evaluation of treatment options, the decision fell on rearticulating with a THR, even though primary surgery lay seven decades back. Since it was not possible to insert an appropriate non-cemented pressfit-cup, an acetabular reinforcement ring and a PE low profile cup were inserted, cemented with less inclination to avoid or reduce hip instability. A fissure around the implant (Wagner cone stem) was secured with numerous cerclages. Surgery was performed by the senior author (A.M.N.) postoperatively, the patient suffered a prolonged delirium. Ten months after surgery, the patient was satisfied with the result and reported a meaningful improvement in his daily quality of life. His mobility increased significantly and represented by his ability to climb stairs without being in pain or needing walking aids. Today, 2 ½ years after THR surgery, the patient still reports being satisfied and pain free. CONCLUSION: Despite transient complications postoperatively, we are happy to report a very satisfactory clinical and radiologic outcome after 10 months. The today 79-year-old patient reports having a higher quality of life since rearticulation of his Girdlestone situation. However, the long-term effects and survival rate of this procedure need to be observed furthermore.