What Is The Girdlestone Procedure For The Hip?

The Girdlestone procedure is a surgery that removes the top of the thigh bone and leaves the hip without a joint. It is used most often to clear a serious infection after a hip replacement, or to remove an infected or failed artificial hip. The result is a hip that no longer has a ball-and-socket joint, so the leg is shorter and walking requires more effort and support.

The name comes from Gathorne Robert Girdlestone, a British surgeon who described the operation in the 1920s and 1940s for treating hip infections. It was once a common way to save a limb from chronic bone infection. Today it is a last-resort operation, used when other options have failed or are too risky. Most people who have it are older or have other serious health problems.

What Is The Girdlestone Procedure For The Hip?

The Girdlestone procedure is an excision arthroplasty. The surgeon removes the femoral head (the ball at the top of the thigh bone) and the femoral neck (the section just below it). The socket of the pelvis, called the acetabulum, is left in place but no longer holds a ball. The space that remains is sometimes called a pseudarthrosis, meaning a false joint.

What forms there is not a true joint. It is scar tissue and fibrous material between the thigh bone and the pelvis. That tissue can allow some movement, but it does not glide like cartilage. The leg becomes shorter, and the hip is less stable. Many people need crutches, a walker, or a cane to get around afterward.

The operation is not a repair. It is a salvage procedure. That means it is done to solve a problem that cannot be fixed another way, not to restore a normal hip. Surgeons generally consider it only when a two-stage revision of an infected hip replacement has failed, when the infection cannot be cleared, or when a person is too frail for a more complex reconstruction.

Why Would Someone Need a Girdlestone Procedure?

The most common reason is a deep infection around an artificial hip that will not go away. Infection after hip replacement is uncommon but serious. Bacteria can form a film on the metal and plastic parts that antibiotics struggle to reach. Removing the implant and the surrounding bone can clear the infection when other treatments have not.

Other reasons include a failed hip replacement in someone who cannot safely have another implant, severe bone loss around the implant, or a hip joint destroyed by long-standing infection of the bone itself. Some surgeons use it as a temporary step, leaving the hip without a joint while infection is treated, with a plan to put in a new replacement later.

It is important to be clear about how often this happens. The Girdlestone procedure is rare. Most infected hip replacements are treated with other methods, such as washing out the joint or exchanging the implant in one or two stages. The Girdlestone is reserved for cases where those approaches are not expected to work or have already failed.

What Happens During the Surgery?

The operation is done under general or spinal anesthesia. The surgeon makes an incision over the hip, usually from the side or back. The femoral head and neck are removed. Any infected tissue, dead bone, and the old implant are taken out. The area is washed thoroughly.

The wound is then closed, sometimes with a drain left in place for a short time. In some cases the surgeon leaves the wound open to heal from the inside, or uses a temporary spacer, depending on the infection and the plan. The hospital stay is often longer than for a routine hip replacement, and antibiotics are usually given for a period afterward.

The exact surgical approach and aftercare vary. These decisions depend on the infection, the person’s overall health, and the surgeon’s judgment. There is no single standard technique that applies to every case.

What Is Recovery and Walking Like After a Girdlestone?

Recovery is slower and harder than after a hip replacement. The leg is shorter, often by a noticeable amount, because the femoral head and neck are gone. That shortening changes posture and gait. Most people need a shoe lift or a built-up shoe on the operated side to help balance the difference.

Walking usually requires support. Many people use crutches or a walker long term, and some manage with a cane. The hip can bear some weight, but it is less stable and less powerful than a natural or replaced joint. Stairs, uneven ground, and long distances are harder. Some people need help at home during recovery.

Pain after surgery varies widely. Some people get relief because the infected or damaged joint is gone. Others have ongoing discomfort from the changed mechanics of the hip and the scar tissue. Physical therapy is often used to build strength and teach safe movement, but it cannot restore a normal joint.

The evidence on how well people function after a Girdlestone is limited and comes mostly from smaller studies and case series. Those reports generally describe acceptable control of infection but reduced function and walking ability compared with a successful hip replacement. That trade-off is central to the decision.

How Does It Compare With Other Hip Operations?

The main alternatives depend on the problem. For an infected hip replacement, surgeons may try washing out the joint and keeping the implant, or removing the implant and putting in a new one in one or two stages. For a failed replacement without infection, a revision hip replacement is often possible. The Girdlestone is considered when these are not safe or have not worked.

Each option has different risks and benefits. A revision can restore a working joint but carries the risk of new infection, loosening, or further surgery. The Girdlestone clears the problem in a different way, at the cost of function. The right choice depends on the infection, the bone, and the person’s health and goals.

What Are the Risks and Limitations?

The Girdlestone procedure carries the risks of any major surgery, including bleeding, blood clots, and problems from anesthesia. Because it is often done in people who are already unwell, those risks can be higher than for routine operations. Infection can recur, and further surgery may be needed.

The main limitation is function. The leg is shorter and the hip is less stable. Walking is harder and often needs support. Some people are able to walk with aids and manage daily activities, while others have more difficulty. The outcome is not predictable from the surgery alone.

There is also an emotional side. Losing a hip joint and needing walking aids is a significant change. It helps to have realistic expectations before surgery and to plan for help at home and for follow-up care.

Is a Girdlestone Procedure Permanent?

Usually it is permanent, but not always. In some cases it is used as a temporary measure while an infection is treated, with the aim of putting in a new hip replacement later if the infection clears and the person is well enough. When it is done as a final salvage operation, the hip stays without a joint.

Whether a later reconstruction is possible depends on the infection, the bone, and the person’s health. That decision is made with the surgical team over time. It is not something to assume either way before surgery.

What Should You Ask Your Surgeon?

If a Girdlestone procedure is being considered, ask why other options are not suitable. Ask what the expected leg length difference will be and what walking aids you will need. Ask about the plan for antibiotics and for follow-up. Ask whether a later hip replacement is possible.

It also helps to ask about the experience of the surgical team with this operation, since it is uncommon. And ask what support you will need at home during recovery. Clear answers to these questions make the decision easier.