The Girdlestone procedure is a surgical option for certain hip conditions when other treatments are unsuitable. Often considered a “salvage” procedure, it is used as a last resort to address complex hip problems. This operation aims to alleviate pain and manage severe issues within the hip joint.
What is the Girdlestone Procedure?
The Girdlestone procedure, also known as excision arthroplasty of the hip or femoral head ostectomy, involves removing the femoral head and neck. This is the “ball” portion of the hip joint and the narrow section connecting it to the main thigh bone. The procedure leaves a gap between the remaining upper part of the femur and the acetabulum, the “socket” of the hip in the pelvis.
The immediate result is the absence of a true ball-and-socket joint. Over time, fibrous tissue forms where the femoral head once was, creating a fibrous pseudarthrosis or “false joint.” This tissue allows for some limited movement but does not replicate the stability or function of a natural hip joint or a prosthetic replacement. The primary goal of this surgical technique is to remove diseased bone and tissue, creating a space that can heal and reduce pain.
Why is it Performed?
The Girdlestone procedure is performed when conventional hip preservation or replacement options are not feasible or have failed. It addresses complex cases, especially when infection is present and uncontrollable. A common indication is a severe infection in a total hip replacement, requiring prosthesis removal to clear the infection.
Other scenarios include severe hip trauma, failed internal fixation of femoral neck fractures, or recurrent hip dislocations that cannot be managed. It is also considered for patients with significant comorbidities, such as advanced chronic conditions, who may not tolerate the extensive surgery required for a total hip replacement. It may also be used for non-ambulatory patients experiencing painful hip dislocations, such as those with cerebral palsy, or for tumors in the hip area.
Life After a Girdlestone Procedure
Life after a Girdlestone procedure involves significant adjustments, as functional outcomes are typically less favorable than with a successful hip replacement. Patients often experience a leg length discrepancy, ranging from 1.5 to 6 centimeters, requiring shoe lifts or other accommodations. This limb shortening, combined with the absence of a stable hip joint, leads to reduced mobility and stability.
Most individuals will require assistive devices such as crutches, canes, or a walker for ambulation; some may rely on a wheelchair. Pain relief is a primary goal, and many patients report satisfactory pain control, though some may still experience moderate to severe pain. Physical therapy plays an important role in rehabilitation, focusing on strengthening surrounding muscles, improving range of motion, and gait training to maximize functional independence. While the procedure effectively eradicates infection and reduces pain, patients generally have a lower quality of life and health status compared to those with successful hip replacements, or even individuals with lower limb amputations. Some patients may eventually be candidates for a total hip arthroplasty at a later stage, once initial issues like infection are resolved.