A Girdlestone procedure is a salvage hip surgery in which the ball of the hip joint (the femoral head) is surgically removed and not replaced with an implant. Instead, scar tissue gradually fills the space where the joint used to be, forming a “pseudo-joint” that allows some limited movement. It is considered a last resort, performed only when infection, failed hip replacements, or other complications make a standard hip implant impossible or too risky.
What Happens During the Surgery
The surgeon removes the femoral head, cutting down to a bony landmark called the lesser trochanter. Any infected or dead bone and soft tissue are cleaned out in a process called debridement. If the procedure is being done to treat a deep joint infection, antibiotic-loaded beads or cement may be packed into the empty socket and surrounding area to fight remaining bacteria. The remaining femur is then positioned near the hip socket, and the surrounding muscles and soft tissue are reattached to provide some stability.
The result is a hip without a true joint. Over the following weeks, scar tissue forms between the pelvis and the shortened femur, creating a fibrous connection that can bear some weight but lacks the smooth, stable movement of a normal hip or a prosthetic one.
Why It’s Performed
The Girdlestone procedure exists for situations where other options have failed or aren’t safe. The most common scenario is a deeply infected hip replacement that hasn’t responded to antibiotics or previous revision surgeries. When infection destroys bone and soft tissue around a prosthetic hip, removing the implant entirely is sometimes the only way to clear the infection. Studies report that the procedure controls infection in the majority of cases, with healing rates between 80% and 100% depending on the patient population.
Some patients undergo the Girdlestone as the first stage of a two-part process: the infected implant is removed, infection is treated, and months later a new hip replacement is implanted. For others, reimplantation is never possible, and the Girdlestone becomes permanent. Absolute reasons for keeping it permanent include patients who cannot walk due to other medical conditions, those whose surgical or anesthetic risk is unacceptably high, cases with technical barriers to reimplantation, or patients who decline further surgery. Relative considerations include dementia (which raises dislocation risk with a new implant), severe immune deficiency, and intravenous drug use.
In rare cases, it may be offered as a primary procedure for very frail, non-ambulatory elderly patients with hip fractures who cannot safely undergo a full hip replacement. But this remains uncommon. Hip replacement is still the preferred treatment for nearly all hip fractures in older adults.
Life After a Girdlestone: What to Expect
The trade-off of this surgery is significant. It relieves infection and often reduces pain, but at a considerable cost to mobility and independence. The affected leg typically ends up 4 to 6 centimeters (roughly 2 to 3 inches) shorter than the other, depending on how much bone was lost. The exact amount of shortening varies with the severity of bone destruction and the quality of scar tissue that forms.
Walking after a Girdlestone procedure is possible for some patients but requires a walking aid permanently. In one study tracking outcomes at one year, 63% of surviving patients were immobile, and every patient who could walk needed a walker frame. Pain persisted in most patients who were mobile. Broader literature paints a slightly more varied picture: roughly 85% of patients report satisfactory pain relief, but residual severe pain occurs in 16% to 33%, moderate pain in 24% to 53%, and mild pain in about 76%. Patient satisfaction rates across studies range widely, from as low as 13% to as high as 83%.
The physical reality is that a Girdlestone hip cannot function like a normal joint. The leg on the affected side has less strength, less range of motion, and less stability. Most people experience a noticeable limp, and many lose a significant degree of independence in daily activities. A shoe lift is typically needed to compensate for the leg length difference.
Risks and Complications
Complication rates following a Girdlestone are among the highest of any elective hip surgery. In a study of 38 patients, 76% experienced at least one complication. Two-thirds had minor complications, and about one-third experienced major ones. Within 90 days of surgery, three patients needed additional operations and four died. Male patients and those with more preexisting health conditions faced significantly higher rates of reoperation and death.
These numbers reflect the fact that patients undergoing this procedure are typically already very sick. They often have multiple prior surgeries, active infections, weakened immune systems, or serious chronic illnesses. The surgery itself is a major operation on a compromised patient, which accounts for the elevated risk.
Can a Hip Replacement Follow Later?
Yes, and this is the preferred path when feasible. Many surgeons plan the Girdlestone as a temporary stage: remove the infected implant, treat the infection with weeks or months of antibiotics, then reimplant a new prosthetic hip once blood tests and tissue samples confirm the infection has cleared. One published case described a patient who lived with a Girdlestone hip for a decade before successfully receiving a total hip replacement, eventually achieving an excellent functional score.
Not everyone is a candidate for reimplantation, though. Severe bone loss, persistent infection, poor overall health, or the patient’s own preference may make a permanent Girdlestone the final outcome. For those who do proceed to reimplantation, the second surgery carries its own risks, and outcomes depend heavily on how much healthy bone remains and the patient’s ability to rehabilitate.
Historical Context
The procedure is named after G.R. Girdlestone, a British orthopedic surgeon who first published the technique in 1943 as a treatment for severe tuberculosis of the hip joint. At a time before effective antibiotics and artificial joints, removing the infected bone was often the only option. After total hip replacement became widely available in the early 1960s, the Girdlestone shifted from a primary treatment to a salvage procedure used mainly for managing failed prosthetic hips. That remains its role today: a surgery no one wants but that, in certain desperate situations, offers the best available path to controlling infection and reducing pain.