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

Background Girdlestone hip resection arthroplasty (GRA) is a salvage procedure reserved for recalcitrant periprosthetic infection, failed arthroplasties, as well as neuromuscular hip dislocations in children. Existing evidence derives largely from single-institution, age-restricted studies. Therefore, the purpose of this study was to report demographic, diagnostic, and complication profiles of GRA across the population in a large retrospective cohort. Methods We conducted a retrospective cohort study using the TriNetX Research Network, a federated network of deidentified electronic health record data. Patients who underwent Girdlestone resection arthroplasty between October 2015 and June 2024 were identified and stratified into pediatric (≤ 18 years) and adult (> 18 years) cohorts. Demographics, the ten most prevalent International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnoses per cohort, and postoperative outcomes, including return to the operating room, pain, opioid use, heterotopic ossification, decubitus ulcers, infection, and death, were assessed. Results A total of 1,876 patients were identified: 87 pediatric (≤ 18 years) and 1,789 adult (> 18 years) patients. The leading pediatric diagnosis was cerebral palsy. The adult diagnostic profile was less homogeneous and included unclassified pain (4%) and other unclassified joint disorder (4%), followed by pressure ulcer, paraplegia/quadriplegia, and cerebral palsy (3% each). A diagnosis of cerebral palsy was present in both cohorts (28% pediatric vs 3% adult). Pain occurred at similar rates in both groups (57.5% pediatric vs 60.8% adult; P = 0.575). Opioid use (11.7%), return to the operating room (10.0%), decubitus ulcers (28.3%), surgical site infection (5.3%), pyogenic arthritis (23.6%), osteomyelitis (12.8%), sepsis (9.1%), and death (11.4%) occurred only in the adult cohort (all P ≤ 0.020). Heterotopic ossification occurred only in adults (1.1%; P = 1.000). Conclusions Girdlestone resection arthroplasty was associated with distinct indications and outcomes across age groups. Pediatric patients underwent the procedure predominantly for neuromuscular hip disease, while adults carried a high burden of infection, reoperation, and mortality. These findings support age-specific risk counseling rather than a single composite risk estimate. Type of study/level of evidence: Retrospective comparative study; Level III.