Question 1

Why would I choose Girdlestone procedure instead of trying to cure the infection and put in a new hip replacement?

Accepted Answer

Girdlestone is a salvage procedure recommended when two-stage revision is not feasible or has failed - most patients would prefer new hip replacement, but Girdlestone may be best option if: (1) YOU'RE TOO SICK FOR COMPLEX SURGERY: Two-stage revision requires TWO major operations 3-6 months apart (total 6-8 months process, two hospital stays 5-10 days each, extensive rehab) - if you have severe heart disease, lung disease, dementia, or frailty, anesthesia risk may be too high for two operations, but single Girdlestone operation safer | (2) MULTIPLE FAILED REVISIONS: If you've already had 2-3 attempts at curing infection (two-stage revisions) and infection keeps coming back, chance of success with another revision very low (30-40%), while Girdlestone has 70-80% infection cure rate | (3) MASSIVE BONE LOSS: If infection destroyed so much bone that there's not enough bone stock left to support new implant, reimplantation may be impossible or very likely to fail - Girdlestone doesn't require good bone stock | (4) PERSONAL CHOICE: Some patients say 'I'm done with surgeries, just take it out and let me live infection-free even if I limp' - understandable after years of infection, pain, antibiotics, multiple operations. Girdlestone is NOT ideal outcome (limp, short leg, walker needed) but for patients who cannot tolerate or have failed complex revisions, it provides reliable infection cure and pain-free walking - many Girdlestone patients are satisfied with outcome saying 'I can walk without pain for first time in years, the limp doesn't bother me.'

Question 2

What will my life be like after Girdlestone procedure - can I walk, drive, live independently?

Accepted Answer

Most Girdlestone patients achieve pain-free walking and independent living, but with significant limitations - you'll walk with limp, need walking stick or frame, have 3-5cm leg shortening requiring shoe lift, and limited hip motion making some activities difficult. WALKING: 70-80% walk independently with stick or walker - can walk short distances (100-500 meters), around house, shops, but not long bushwalks or extensive walking - limp is permanent due to leg shortening and unstable pseudo-joint (scar tissue connection lacks strength of normal hip joint) | DRIVING: Most can drive automatic car (right hip Girdlestone) - may need pedal extensions if leg shortened, getting in/out of car difficult (limited hip flexion) | STAIRS: Difficult due to limited hip motion - need handrail, one step at a time (good leg up first, bad leg down first) | SITTING: Can sit in regular chairs but getting up requires assistance or arms to push - low chairs very difficult (limited hip flexion) | SHOES/SOCKS: Difficult to put on due to limited hip flexion - may need long-handled shoe horn, sock aid, or assistance | HOUSEHOLD TASKS: Can perform most activities - cooking, light housework, showering (with grab rails) - heavy tasks difficult (vacuuming, gardening) | SPORTS: No running, jumping, or impact activities - gentle swimming possible, stationary bike, walking only exercise | PAIN: 70-80% pain-free or minimal pain (much better than chronic infection pain) - some have residual discomfort with prolonged walking | INDEPENDENCE: Most live independently (not requiring full-time care), but may need assistance with some activities (putting on shoes, heavy housework, long shopping trips). REALISTIC EXPECTATIONS: Girdlestone is NOT as good as successful hip replacement (which allows near-normal walking without aids) - but for patients with chronic infection who have failed other treatments, Girdlestone provides acceptable quality of life (pain-free, mobile with aids, living at home independently).

Question 3

Is it possible to convert Girdlestone to a hip replacement later if my health improves or I change my mind?

Accepted Answer

Technically possible but very difficult with low success rates (50-60% compared to 85-95% for standard two-stage revision) - conversion from Girdlestone to hip replacement is complex operation with high complication risk and usually only considered in younger patients (under 60-65) who are significantly limited by Girdlestone and willing to accept risks. WHY CONVERSION DIFFICULT: MASSIVE BONE LOSS: After Girdlestone, femur bone shortened 3-5cm and pelvis/acetabulum bone often eroded by previous infection - reconstructing hip requires bone grafting (using donor bone or metal augments) which has lower success rate | MUSCLE DAMAGE: Hip muscles (abductors) severely weakened or scarred after Girdlestone - even if implant inserted successfully, weak muscles mean poor hip function (persistent limp, Trendelenburg gait) | INFECTION RISK: Reinserting implant carries 10-20% risk of re-infection (bacteria may still be dormant in bone) compared to 1-2% infection risk in primary hip replacement | TECHNICAL DIFFICULTY: Scar tissue from multiple previous surgeries makes operation extremely challenging (identifying anatomy, vascular injury risk, nerve damage risk). CONVERSION RESULTS: Success rate 50-60% (achieve working hip replacement without complications) | 10-20% develop re-infection requiring another Girdlestone or permanent antibiotics | 20-30% have implant instability/dislocation due to bone loss and weak muscles | Even if successful, walking ability usually worse than standard hip replacement (persistent limp, need for stick) due to muscle damage. WHEN CONVERSION CONSIDERED: Young patient (under 60-65) significantly disabled by Girdlestone (cannot work, very limited mobility) | At least 1-2 years after Girdlestone (ensure infection fully cured - check blood markers, imaging) | Good bone stock remaining (CT scan shows adequate bone for implant fixation) | Realistic expectations (understanding conversion is high-risk, may not restore normal walking). MOST COMMON APPROACH: If you're considering Girdlestone but worried about permanent limitation, better to attempt one more two-stage revision (if medically fit) rather than Girdlestone - easier to succeed with revision BEFORE Girdlestone than trying to convert AFTER Girdlestone. Once Girdlestone done, best to accept it as permanent solution rather than hoping for future conversion.

Medical Disclaimer

Girdlestone Procedure (Hip Without Replacement)

📖What is Girdlestone Procedure (Hip Without Replacement)?