Girdlestone excision arthroplasty is an operation to remove a failed or infected hip replacement, leaving the hip without a prosthesis. It is a salvage procedure performed when reimplantation is not possible or as a staged procedure before reimplanting a new hip.
An incision is made over the hip (often reopening the previous surgical incision). All prosthetic components, cement, and infected or dead tissue are removed. The wound is thoroughly washed. Antibiotic-loaded cement beads or a spacer may be placed temporarily. The wound is closed, leaving the hip without a prosthesis. The operation takes one and a half to three hours.
Girdlestone excision is performed for chronic periprosthetic joint infection that cannot be eradicated with implant retention, failed hip replacement with insufficient bone for revision in patients not fit for complex reconstruction, and as the first stage of a two-stage revision for infection (spacer insertion before reimplantation).
Long-term antibiotic suppression of infection (accepting the infected implant), palliative care, and above-knee amputation in extreme cases. Two-stage revision (spacer followed by reimplantation) is the preferred approach when the patient is suitable.
Joint aspiration for microbiology. Blood tests including inflammatory markers. Assessment of bone stock and soft tissue condition. MDT discussion involving microbiologists and infectious disease specialists.
Eradication of infection. Pain relief from removing the loose or infected prosthesis. If planned as a two-stage procedure, reimplantation of a new hip can be performed once infection is cleared (usually three to six months later).
Significant shortening of the affected leg. A shoe raise is needed.
Significant limp without a prosthesis. Crutches or walking aids required permanently if reimplantation is not performed.
Loss of hip abductor function.
Some patients have ongoing discomfort.
Infection may not be fully eradicated.
Particularly in previously operated, irradiated, or infected tissue.
If an antibiotic spacer is used.
Many patients undergoing Girdlestone are elderly with significant comorbidities.
General or spinal anaesthesia. Patient may be medically complex.
Hospital stay one to two weeks or longer. Mobilisation with walking aids. If planned for reimplantation, six to twelve weeks of intravenous or oral antibiotics before the second stage. If a permanent Girdlestone, lifelong use of walking aids and shoe raise.
Regular blood tests to monitor infection markers. If two-stage planned, joint aspiration before reimplantation to confirm infection clearance.
If the infection is cleared, most patients are suitable for reimplantation of a new hip (second stage of two-stage revision). This typically occurs three to six months after the Girdlestone, once infection markers have normalised and aspiration confirms no residual infection.
Yes, but with a significant limp, leg shortening, and the need for walking aids. Function is limited but pain relief is usually good.