What Is The Girdlestone Procedure And Why Is It Done?

The Girdlestone procedure is a salvage surgery that removes the head and neck of the thigh bone (femur) to treat severe hip infections or pain when other options have failed. It is a last-resort operation designed to eliminate infection and stop pain, not to restore normal hip function. The procedure leaves the hip joint permanently without its ball-and-socket structure, relying on scar tissue to form a false joint over time.

What Is The Girdlestone Procedure And Why Is It Done

The Girdlestone procedure, formally called excision arthroplasty of the hip, is a surgery that removes the femoral head and neck. The surgeon takes out the top part of the thigh bone that normally fits into the hip socket. This creates a gap between the remaining thigh bone and the pelvis.

Surgeons use this operation when the hip joint is severely infected or destroyed and cannot be saved. It is not a first-choice treatment. It is a salvage operation, meaning it is used when other surgeries have failed or are not possible.

The most common reason is a deep infection around a hip replacement. When an artificial hip becomes infected and cannot be cleared with antibiotics or revision surgery, removal of the joint may be the only way to stop the infection from spreading. The procedure is also used for severe bone loss, advanced arthritis in frail patients, or fractures that cannot be repaired.

How The Surgery Works

The surgeon makes an incision over the hip and removes the femoral head and neck. The acetabulum, the cup-shaped socket in the pelvis, is left intact but is cleaned of any infected or damaged tissue.

After removal, the surgeon closes the wound with the remaining muscle and soft tissue placed in the empty space. Over the following weeks, this tissue forms a dense scar that acts as a cushion between the thigh bone and the pelvis. This scar tissue is the “false joint” that allows some movement, though not a normal range of motion.

The surgery takes about one to two hours under general or spinal anesthesia. Patients typically stay in the hospital for several days to receive intravenous antibiotics and begin physical therapy.

Why Surgeons Choose This Over Other Options

When a hip replacement becomes infected, the standard approach is a two-stage revision. In the first stage, the surgeon removes the artificial joint and inserts a temporary spacer made of antibiotic-loaded cement. After weeks of antibiotics, the second stage places a new hip replacement.

The Girdlestone procedure is chosen when a two-stage revision is not feasible. This happens when the infection involves resistant bacteria, when there is too much bone loss to support a new implant, or when the patient is too sick for a long complex surgery.

It is also used in patients with poor skin coverage, significant medical problems, or those who cannot tolerate another major operation. For these individuals, removing the joint permanently may be safer than attempting another replacement.

What To Expect After Surgery

Recovery from a Girdlestone procedure is different from recovery from a hip replacement. The leg on the operated side will be shorter than the other leg, often by one to three centimeters. Patients typically need a shoe lift to help them walk.

Walking requires significant effort. Most patients use a walker or crutches permanently because the hip lacks its normal bony support. Physical therapy focuses on strengthening the core, back, and remaining leg muscles to compensate for the lost joint.

Pain relief is usually excellent for the infection itself. The severe pain from the infected joint typically resolves after surgery. However, patients may experience new discomfort from the leg length difference or from strain on the lower back and opposite hip.

Most patients can walk short distances indoors with a walker. Few are able to walk long distances or climb stairs without significant difficulty. The trade-off is acceptable for many because the surgery eliminates a life-threatening infection that was causing severe pain.

Risks And Complications

The Girdlestone procedure carries serious risks, as do all major hip operations. Infection can persist despite removal of the joint, especially if the bacteria are resistant to antibiotics. Bleeding, blood clots, and nerve damage are possible, though uncommon.

Heterotopic ossification is a specific complication of this surgery. This is the growth of new bone in the soft tissues around the hip. It can limit movement further and cause additional pain, though it does not affect everyone.

The surgery also places stress on other joints. Because the hip no longer functions normally, the lower back, opposite hip, and knees take on extra load. Over time, this can lead to arthritis or pain in those areas.

Mortality risk is higher than for routine hip replacement because patients who need this surgery are often older and have multiple medical problems. Studies consistently show that the procedure is reserved for patients who have few other options.

Success Rates And Long-Term Outcomes

The primary goal of the Girdlestone procedure is to cure the infection. When successful, the infection clears and the patient is free of the severe pain that prompted the surgery. Most patients report significant improvement in quality of life compared to living with an infected hip.

However, functional outcomes are limited. Research consistently shows that most patients require a walking aid permanently. Only a minority of patients can walk independently without support.

Some patients eventually undergo a second surgery to place a new hip replacement after the infection has been cured. This is called a conversion arthroplasty. It is possible in some patients but is a major operation with higher risks than a first-time replacement.

The decision to attempt a new replacement depends on the patient’s overall health, the amount of remaining bone, and whether the infection is truly gone. Many patients choose to stay with the Girdlestone result rather than risk another major surgery.

Alternatives And When They Are Used

Before recommending a Girdlestone procedure, surgeons exhaust other options. Antibiotic therapy alone rarely cures an infected hip replacement because bacteria form a biofilm on the metal and plastic surfaces that antibiotics cannot penetrate.

Debridement with implant retention is an option in very early infections. The surgeon cleans the joint and replaces the plastic liner but keeps the metal parts. This works only if the infection is caught within weeks of onset and the implant is firmly fixed.

One-stage revision replaces the entire hip in a single operation. This is used for less aggressive infections but has a higher failure rate than two-stage revision for resistant bacteria.

Two-stage revision remains the gold standard for infected hip replacements in patients healthy enough to undergo two operations. The Girdlestone procedure is reserved for those who cannot safely complete this process.

Life After A Girdlestone Procedure

Adjusting to life after this surgery takes time and patience. The leg length difference is the most noticeable change. A properly fitted shoe lift can improve walking and reduce back strain.

Physical therapy is essential. Strong core and arm muscles make transfers and walking easier. Many patients find that swimming or water-based exercise helps maintain strength without putting weight on the hip.

Daily activities like dressing, bathing, and using the toilet may require adaptive equipment. A raised toilet seat, shower chair, and long-handled aids can make these tasks safer and more manageable.

Most patients adapt well over time. The absence of infection and severe pain outweighs the functional limitations for most people who undergo this procedure. It is a difficult surgery with a long recovery, but for the right patient, it is a life-saving and life-improving option.