Girdle Stone Summary

Girdle Stone Summary

The original post:
Looking for a prosthetic prescription for a moderately long trans femoral
amputee who had a Girdle Stone procedure. He had it done 30 years ago but
just recently became an amputee.

He has weak extensors, flexors, ad &abductors but a strong sound side and
good upper body strength and balance.

Also requestin advice concerning the potential problems with this type of
amputation. Thank you for your help.

Mark Benveniste CP

There was some confusion about the spelling and exactly what the Girdle Stone
is-Clarification follows along with seasoned advice. MB
---------------------
Girdlestone is a resection arthroplasty done for many reasons when
replacement is not advisable or possible. It renders the hip joint unstable
so the usual orthotic treatments using orthoses needing the stability of the
normal hip joint are impossible.

Donald Shurr, CPO,PT
----------------------------
Mark,
Girdlestone is a type of proximal femoral resection- so you really do not
have a good hip joint. Usually done because of severe hip pain and
reconstruction or replacement not feasible. We have a young man who walks
on his though very limited weight bearing using a walker. I would think
any prosthetic should have a hip joint and good pelvic band or molding
because even if the femur is more or less in the acetabulum it is not a
very stable arrangement. There is often a lot of pistoning. What is this
person's gait like before the amputation?

Vikki Stefans, pediatric physiatrist (rehab doc for kids) and working
Mom of Sarah T. and Michael C., aka <Email Address Redacted>
Arkansas Children's Hospital/ U of A for Medical Sciences, Little Rock
...and EVERY mom is a working mom! (OK, dads too...)

------------------------------
Mark,
Here in Australia it is known and spelt as a Girdlestone's procedure. This
involves the end of the femoral shaft being placed into the acetabulum, (or
even against the pelvic crest) as you describe, or any other end left when
the articulating surface is removed.
It has often been done when a Hip replacement has failed, or was
contraindicated for whatever reason. As you can imagine it leaves a very
short leg on that side, and footwear build-ups (I have seen 6-7!) are
necessary. I have also seen two cases where the shaft of the femur actually
punctured the pelvic crest in severely osteoporotic patients following such
surgery and too aggressive shoe build-ups.
regards, Richard Ziegeler

<Email Address Redacted>
-----Original Message-----
From: <Email Address Redacted> < <Email Address Redacted> >
To: <Email Address Redacted> < <Email Address Redacted> >
Date: Thursday, 19 August 1999 15:35

-----------------------
I had a BK patient recently with a Girdlestone procedure and will share my
limited experience. He was about 70 and quite weak, so your patient has a
lot more going for him. Depending on the length of femur removed, there will
be some degree of lateral instability so I would certainly keep a high
lateral wall & cut it down after you see him weight bearing. If you get good
ischial support there should not be a lot of telescoping & since it has
been years since the procedure, there should be capping of the femoral
segment. You are likely to have more problems with rotation, so I would
consider a hip joint & pelvic band(heavy duty).

I was able to utilize a tilt table on the first fitting which allowed me to
gradually increase weight bearing so see what was going on at the hip. Much
to my surprise, here was little telescoping or lateral shift. I was able to
fit him with joints & corset because his knee problems turned out to be more
of a problem than his hip. He walked 25 ft at best in therapy,but now uses it
mostly for transfers and limited walking-which was a success I believe.


Gerald L Martin CPO
---------------------------------
Hi mark,
    You may want to consider a well contoured C. A. T. C. A. M. (IC) socket.
 Given the G. S. condition of the hip are you will need to really lock and
capture the Ischial-PubicRamus area and really get support from the Gluteal
muscles and former Throcanter areas. Depending on the residual limb muscle
structure and condition, you may want to avoid full suction unless you will
be using some form of silicone liner. A molded pelvic section with a
hip-joint will add to the support and control that your patient may/will
need. Sometimes you can substitute a molded leather pelvic belt. When you
take your impression of the residual limb, use the impression as a check
socket, hold the impression to the patient in a normal position and then,
while the patient is partially wieght-bearing into the impression, have some
cast around the hip and waist areas, including the impression of the residual
limb. This may sound like extra work, but the fabrication, fitting, etc.,
will work out better in the long run.
    I have worked with and fitted a number of amputees with GS procedures and
found this particular technique to work well. There are other procedures,
but this may be more successful for you.
    I would recommend a light weight polycentric knee and an Otto Bock 1D10
foot.
Email me if you have any specific questions.

Good Luck!
Robert L. Hrynko, CPO.

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