For the treatment of chronic sepsis of the hip in paraplegic patients,
we adopted three measures: (1) a Girdlestone procedure, (2) transposition
of the vastus lateralis muscle into the void that was left by the removal
of the femoral head and neck and the acetabular wall, and (3) external
fixation to prevent unrestrained motion of the femoral shaft, which might
damage the transposed muscle. The hip joint was spanned by a posterior
pelvic-femoral skeletal external fixator. Nine patients, all of whom had
thoracic-level paraplegia, were treated in this manner. The fixator was
kept in place for three to six weeks while the patients were cared for in
the prone position. All of the infections were fully healed by twelve weeks
postoperatively. In two patients, the wound drained at the edge of the flap
for a short time.