Spacer-free but prolene mesh-supported girdlestone resection arthroplasty achieves reliable ınfection eradication and pain relief in high-risk patients: 5-year outcomes.

Abstract

<h4>Objective</h4>Girdlestone resection arthroplasty (GRA) remains the final salvage procedure for eradicating chronic hip infections, particularly in cases where reimplantation is not feasible. However, data on GRA performed without an antibiotic spacer are limited. This study aimed to evaluate mid-term infection control, patient-centered functional outcomes, and associated risk factors in patients who underwent spacer-free but prolene mesh-supported GRA.<h4>Methods</h4>Twenty patients (mean age: 62.2 ± 17.1; 9 males and 11 females) who underwent spacer-free GRA between 2011 and 2020 and were followed for at least 5 years were retrospectively reviewed. Demographic data, comorbidities (ASA, Charlson Comorbidity Index, corticosteroid use), surgical and microbiological characteristics, and functional scores (Merle d'Aubigné-Postel [MAP], Harris Hip Score [HHS], Oxford Hip Score [OHS], visual analog scale [VAS], and walking distance) were recorded. Subgroup analyses were performed according to LLD ≥ 5 cm, corticosteroid use, and ASA ≥ 3. Infection-free survival was assessed using Kaplan-Meier analysis.<h4>Results</h4>At five-year follow-up, infection-free survival was observed in all patients (100%; 95% CI 83-100). The mean MAP score increased from 6.0 to 8.0 (mean difference = 2.0 [CI 0.5-3.5]; p = 0.22), HHS from 30.0 to 35.0 (p = 0.18), and OHS from 15.0 to 18.0 (p = 0.24). VAS at rest decreased significantly (4.5 → 3.0; p = 0.04), and walking distance increased from 120 to 355 m (p = 0.01). Patients with LLD ≥ 5 cm had significantly lower MAP scores (p = 0.04). These findings represent observational outcomes derived from a retrospective single-arm case series.<h4>Conclusion</h4>Spacer-free but prolene mesh-supported GRA may represent a viable salvage option for infection control and pain relief in high-risk patients, although functional recovery remains limited.