The Girdlestone procedure for the hip is a specific type of orthopedic surgery reserved for complex and challenging joint conditions. Surgeons frequently refer to it as a “salvage” operation, typically considered when common reconstructive options, such as a total hip replacement, are not possible or have failed. This procedure addresses severe issues within the hip joint, aiming to alleviate pain and manage life-threatening complications. It remains an important surgical option for patients facing certain dire hip conditions.
Defining the Procedure and Its Purpose
The Girdlestone procedure, technically known as an excision arthroplasty, involves removing the ball portion of the hip’s ball-and-socket joint. The surgeon resects the femoral head and neck—the top part of the thigh bone—without replacing it with an artificial implant. This removal leaves a gap between the remaining thigh bone and the hip socket (acetabulum), allowing surrounding muscles and scar tissue to stabilize the area. The resulting condition is known as a pseudoarthrosis, or a “false joint,” where the bones are no longer directly connected.
The procedure is primarily indicated for two specific, high-risk situations. The most common modern use is to treat a severe, deep prosthetic joint infection (PJI) that has developed after a total hip replacement (THR). When the infection cannot be cleared with antibiotics and debridement alone, the removal of the infected implant is necessary, and the Girdlestone creates an environment for the infection to resolve. It is also performed in elderly or severely debilitated patients with complex hip fractures who are unsuitable candidates for major reconstructive surgery.
Surgical Technique and Approach
The operation begins with an incision made over the hip, allowing access to the joint capsule. If a hip replacement is present, the surgeon first removes all components of the existing implant, including the stem, ball, and socket liner. The defining step of the Girdlestone procedure is the careful resection of the femoral head and neck using an oscillating saw.
Once the bone segment is removed, the surgical field is thoroughly cleaned in a process called debridement, which is especially important in cases of infection. All infected or necrotic tissue is meticulously scraped away to ensure a clean environment. In a two-stage revision for PJI, the surgeon may place an antibiotic-loaded cement spacer into the hip area to deliver high concentrations of antibiotics directly to the site. The wound is then closed over a drain, leaving the remaining proximal femur stabilized only by soft tissues.
Post-Operative Recovery and Rehabilitation
Immediate recovery focuses on pain management and preventing complications, with patients often spending a few days in the hospital. Unlike a standard hip replacement, which encourages immediate, full weight-bearing, the Girdlestone procedure requires a period of protected or non-weight-bearing status. The initial goal is to allow the soft tissues around the hip to heal and form a dense, fibrous scar tissue mass that provides stability for the new joint.
Physical therapy (PT) typically begins soon after surgery, concentrating on maintaining range of motion and strengthening the hip and leg muscles. Rehabilitation is crucial for maximizing the functional outcome, which depends highly on the strength of the remaining musculature. Patients must learn to adapt to the new, unstable joint, retraining their muscles to control the limb’s movement. Early mobilization and PT are essential for achieving the best functional result.
Functional Outcomes and Long-Term Mobility
The long-term reality of the Girdlestone procedure is a significant change in the patient’s gait and limb function. Because the femoral head is removed, the thigh bone is pulled upward by the surrounding muscles, resulting in a noticeable leg length discrepancy (LLD). This shortening typically ranges from 3 to 10 centimeters, leading to an altered gait pattern, commonly referred to as a limp.
The primary functional outcome is the relief of severe pain and the eradication of chronic infection. However, the procedure does not restore normal hip function, and patients usually require permanent walking aids for ambulation. Many patients rely on a cane, crutches, or a walker, and a significant portion may become dependent on a wheelchair for mobility. While the goal is pain-free, limited ambulation, long-term mobility is generally lower than after a successful total hip replacement.