Age-Stratified Indications and Complications of Girdlestone Hip Resection Arthroplasty: A Retrospective Cohort Study

The human hip is a remarkable engineering feat, a ball-and-socket joint that allows us to walk, run, and carry the weight of our bodies with ease. But when this joint fails, the consequences can be devastating. Sometimes, a hip replacement, which is usually a successful solution, becomes infected or fails to heal. In other cases, severe neurological conditions can cause the hip to dislocate and become unbearably painful, especially in children who cannot communicate their discomfort. When the joint is too damaged to be saved or rebuilt, surgeons sometimes turn to a drastic measure known as a Girdlestone resection arthroplasty. This is not a repair; it is a removal. The surgeon takes out the top part of the thigh bone and the hip socket, leaving a gap where the joint used to be. The body eventually fills this space with scar tissue, creating a false joint that allows for some movement, though the leg often becomes shorter and weaker. For decades, this procedure has been a last resort, a way to stop pain or clear a stubborn infection when nothing else works. However, because it is a salvage operation used for very different reasons in children versus adults, doctors have long wondered if the risks and outcomes are the same for everyone, or if age changes the story entirely.

To answer this question, a team of researchers from several major medical centers in the United States looked back at a massive collection of medical records. They did not study a small group of patients at a single hospital, which can sometimes give a skewed picture. Instead, they used a secure, national network of electronic health records to find nearly two thousand people who had undergone this specific hip removal surgery between 2015 and 2024. By sorting these patients into two groups—those eighteen years old or younger, and those older than eighteen—the team could compare exactly who was getting the surgery, why they were getting it, and what happened to them afterward. Their goal was to see if the procedure meant the same thing for a child with a neurological disorder as it did for an elderly adult with a failed hip replacement.

The results revealed that while the surgery code was the same, the patients were worlds apart. The group of children, numbering eighty-seven, was almost entirely made up of young people with severe neuromuscular conditions. The most common diagnosis among them was cerebral palsy, a condition that affects muscle control and movement. Many of these children also had epilepsy, scoliosis, or difficulty swallowing. For them, the surgery was a way to manage a painful, dislocated hip that could not be fixed because their bodies were too fragile or their muscles too uncooperative for a standard replacement. In contrast, the adult group, which included nearly eighteen hundred people, had a much more varied mix of problems. Their reasons for surgery were less concentrated on a single disease and more focused on the aftermath of other medical struggles. The most common reasons included unexplained pain, other joint disorders, and severe pressure sores, often found in patients who were bedridden or had spinal cord injuries. While a small number of adults also had cerebral palsy, the vast majority were older adults dealing with infections, failed previous hip surgeries, or fractures.

The most striking difference appeared when the researchers looked at what happened after the operation. For the children, the surgery seemed to address the immediate structural problem without triggering the severe complications seen in the older group. In the pediatric cohort, the researchers found no recorded instances of the surgery failing, no return trips to the operating room, and no deaths linked to the procedure. The children did experience pain, which is common after such a major operation, but they did not suffer from the cascade of infections or systemic failures that plagued the adults. The adult group, however, faced a heavy burden of complications. More than a quarter of the adults developed pressure sores, and nearly a quarter suffered from serious bone or joint infections. About eleven percent of the adult patients died within the study period, and ten percent had to return to the operating room for further treatment. The adults also faced higher rates of sepsis, a life-threatening response to infection, and a need for strong pain medication.

The researchers noted that the absence of complications in the children might not mean the procedure is risk-free for them, but rather that the specific dangers they faced were different. The children in the study were young and generally healthy aside from their neurological conditions, whereas the adults were often older and carrying multiple, severe health issues that made them vulnerable to infection and death. The study suggests that the Girdlestone procedure is not a one-size-fits-all solution. For a child with cerebral palsy, it is a targeted intervention for a specific mechanical problem. For an elderly adult, it is often a desperate measure taken when the body is already failing from infection or other systemic diseases. The pain of the surgery was felt by both groups, but the path to recovery and the risks of the future diverged sharply based on age.

This large-scale look at the data confirms what doctors have suspected for years: the context of the patient matters as much as the surgery itself. The study does not claim that the procedure is safe for everyone, nor does it suggest that the risks for children are zero, as the number of children in the study was relatively small. Instead, it provides a clear picture that the risks are heavily concentrated in the adult population, driven by the complex web of infections and frailty that often accompanies the need for this surgery in older patients. By separating the two groups, the researchers show that a single risk estimate cannot apply to all patients. When a doctor discusses this difficult option with a family, the conversation must be tailored to the specific age and health profile of the patient, acknowledging that the journey after the surgery will look very different for a child than it will for an adult.