{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"Research Square"}],"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T05:06:01Z","timestamp":1789362361066,"version":"build-2803163510"},"posted":{"date-parts":[[2026,9,14]]},"group-title":"In Review","reference-count":23,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,8,13]]},"abstract":"<title>Abstract<\/title>\n                <p>Background\n 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.\nMethods\n 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 (\u2264\u200918 years) and adult (&gt;\u200918 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.\nResults\n A total of 1,876 patients were identified: 87 pediatric (\u2264\u200918 years) and 1,789 adult (&gt;\u200918 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\u2009=\u20090.575). 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\u2009\u2264\u20090.020). Heterotopic ossification occurred only in adults (1.1%; P\u2009=\u20091.000).\nConclusions\n 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.\nType of study\/level of evidence:\n Retrospective comparative study; Level III.<\/p>","DOI":"10.21203\/rs.3.rs-10695380\/v1","type":"posted-content","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T04:53:21Z","timestamp":1789361601000},"source":"Crossref","is-referenced-by-count":0,"title":["Age-Stratified Indications and Complications of Girdlestone Hip Resection Arthroplasty: A Retrospective Cohort Study"],"prefix":"10.21203","author":[{"given":"Carolyn","family":"Henein","sequence":"first","affiliation":[{"name":"The University of Texas Medical Branch at Galveston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Eusebio","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Hamad","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Pearce","sequence":"additional","affiliation":[{"name":"University of Vermont"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Liu","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Truong","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark M","family":"Herbert","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chinonyelum","family":"Ikeanyi","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Hsue","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ava","family":"Jafarpour","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Chukwu","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricio","family":"Silva","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soroush","family":"Baghdadi","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-007-0082-6","author":"Girdlestone GR","year":"1943","unstructured":"Girdlestone GR. Acute pyogenic arthritis of the hip: an operation giving free access and effective drainage. 1943. Clin Orthop. 2008;466(2):258\u2013263. 10.1007\/s11999-007-0082-6"},{"issue":"5","key":"ref2","doi-asserted-by":"publisher","first-page":"203","DOI":"10.7150\/jbji.36618","article-title":"The Girdlestone situation: a historical essay","volume":"4","author":"Vincenten CM","year":"2019","unstructured":"Vincenten CM, Gosens T, van Susante JC, Somford MP. The Girdlestone situation: a historical essay. J Bone Jt Infect. 2019;4(5):203\u20138. 10.7150\/jbji.36618.","journal-title":"J Bone Jt Infect"},{"issue":"4","key":"ref3","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/j.ijsu.2011.01.012","article-title":"Girdlestones excision arthroplasty: Current update","volume":"9","author":"Basu I","year":"2011","unstructured":"Basu I, Howes M, Jowett C, Levack B. Girdlestones excision arthroplasty: Current update. Int J Surg. 2011;9(4):310\u20133. 10.1016\/j.ijsu.2011.01.012.","journal-title":"Int J Surg"},{"issue":"5","key":"ref4","doi-asserted-by":"publisher","DOI":"10.33552\/GJOR.2024.04.000593","article-title":"Girdlestone resection arthroplasty: indications, outcomes, and complications","volume":"4","author":"Nester M","year":"2024","unstructured":"Nester M, Rivera R, Kittur K, Alford N, Huynh TH. Girdlestone resection arthroplasty: indications, outcomes, and complications. Glob J Orthop Res. 2024;4(5). 10.33552\/GJOR.2024.04.000593.","journal-title":"Glob J Orthop Res"},{"issue":"7","key":"ref5","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.1016\/j.arth.2015.02.011","article-title":"Complication, survival, and reoperation rates following Girdlestone resection arthroplasty","volume":"30","author":"Malcolm TL","year":"2015","unstructured":"Malcolm TL, Gad BV, Elsharkawy KA, Higuera CA. Complication, survival, and reoperation rates following Girdlestone resection arthroplasty. J Arthroplasty. 2015;30(7):1183\u20136. 10.1016\/j.arth.2015.02.011.","journal-title":"J Arthroplasty"},{"issue":"9","key":"ref6","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOSGlobal-D-24-00005","article-title":"Patient factors associated with reimplantation after Girdlestone resection arthroplasty for treatment of periprosthetic joint infections of the hip","volume":"8","author":"Okewunmi J","year":"2024","unstructured":"Okewunmi J, Yendluri A, Cordero JK, et al. Patient factors associated with reimplantation after Girdlestone resection arthroplasty for treatment of periprosthetic joint infections of the hip. JAAOS Glob Res Rev. 2024;8(9). 10.5435\/JAAOSGlobal-D-24-00005.","journal-title":"JAAOS Glob Res Rev"},{"issue":"5","key":"ref7","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1177\/11207000221126135","article-title":"What is the outcome after a Girdlestone resection arthroplasty following a hip fracture?","volume":"33","author":"Shah N","year":"2023","unstructured":"Shah N, Parker MJ. What is the outcome after a Girdlestone resection arthroplasty following a hip fracture? Hip Int. 2023;33(5):948\u201351. 10.1177\/11207000221126135.","journal-title":"Hip Int"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"61","DOI":"10.2340\/17453674.2024.34901","article-title":"Girdlestone resection arthroplasty for femoral neck fractures has poorer outcomes than hemiarthroplasty in frail patients with increased risk for arthroplasty-related complications: a retrospective case study of 21 patients","volume":"95","author":"Bellova P","year":"2024","unstructured":"Bellova P, Linne M, Postler AE, G\u00fcnther KP, Stiehler M, Goronzy J. Girdlestone resection arthroplasty for femoral neck fractures has poorer outcomes than hemiarthroplasty in frail patients with increased risk for arthroplasty-related complications: a retrospective case study of 21 patients. Acta Orthop. 2024;95:61\u20136. 10.2340\/17453674.2024.34901.","journal-title":"Acta Orthop"},{"issue":"8","key":"ref9","doi-asserted-by":"publisher","first-page":"782","DOI":"10.3390\/antibiotics13080782","article-title":"Poor outcomes of Girdlestone resection arthroplasty in injection drug users: a retrospective study","volume":"13","author":"Ghanem D","year":"2024","unstructured":"Ghanem D, Covarrubias O, Elsabbagh Z, et al. Poor outcomes of Girdlestone resection arthroplasty in injection drug users: a retrospective study. Antibiotics. 2024;13(8):782. 10.3390\/antibiotics13080782.","journal-title":"Antibiotics"},{"issue":"6","key":"ref10","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1097\/SAP.0000000000000706","article-title":"The Modified Girdlestone Procedure With Muscle Flap for Management of Pressure Ulcers and Heterotopic Ossification of the Hip Region in Spinal Injury Patients: A 15-Year Review With Long-term Follow-up","volume":"77","author":"Rubayi S","year":"2016","unstructured":"Rubayi S, Gabbay J, Kruger E, Ruhge K. The Modified Girdlestone Procedure With Muscle Flap for Management of Pressure Ulcers and Heterotopic Ossification of the Hip Region in Spinal Injury Patients: A 15-Year Review With Long-term Follow-up. Ann Plast Surg. 2016;77(6):645. 10.1097\/SAP.0000000000000706.","journal-title":"Ann Plast Surg"},{"issue":"8","key":"ref11","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.2106\/00004623-197860080-00005","article-title":"Proximal femoral resection-interposition arthroplasty","volume":"60","author":"Castle ME","year":"1978","unstructured":"Castle ME, Schneider C. Proximal femoral resection-interposition arthroplasty. J Bone Joint Surg Am. 1978;60(8):1051\u20134.","journal-title":"J Bone Joint Surg Am"},{"issue":"6","key":"ref12","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1097\/01241398-198611000-00007","article-title":"Proximal femoral resection-interposition arthroplasty: salvage hip surgery for the severely disabled child with cerebral palsy","volume":"6","author":"Baxter MP","year":"1986","unstructured":"Baxter MP, D\u2019Astous JL. Proximal femoral resection-interposition arthroplasty: salvage hip surgery for the severely disabled child with cerebral palsy. J Pediatr Orthop. 1986;6(6):681\u20135.","journal-title":"J Pediatr Orthop"},{"issue":"1","key":"ref13","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1080\/17453670902804935","article-title":"Proximal femoral resection arthroplasty for patients with cerebral palsy and dislocated hips: 20 patients followed for 1\u20136 years","volume":"80","author":"Knaus A","year":"2009","unstructured":"Knaus A, Terjesen T. Proximal femoral resection arthroplasty for patients with cerebral palsy and dislocated hips: 20 patients followed for 1\u20136 years. Acta Orthop. 2009;80(1):32\u20136.","journal-title":"Acta Orthop"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1007\/s11832-016-0775-z","article-title":"Proximal femur prosthetic interposition arthroplasty for painful dislocated hips in children with cerebral palsy","author":"Silverio AL","unstructured":"Silverio AL, Nguyen SV, Schlechter JA, Rosenfeld SR. Proximal femur prosthetic interposition arthroplasty for painful dislocated hips in children with cerebral palsy. J Child Orthop. Published online 2016. 10.1007\/s11832-016-0775-z","journal-title":"J Child Orthop"},{"issue":"4","key":"ref15","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1097\/BPB.0000000000000566","article-title":"Outcomes of salvage hip surgery in children with cerebral palsy","volume":"28","author":"Chan P","year":"2019","unstructured":"Chan P, Hsu A, Godfrey J, et al. Outcomes of salvage hip surgery in children with cerebral palsy. J Pediatr Orthop B. 2019;28(4):314\u20139. 10.1097\/BPB.0000000000000566.","journal-title":"J Pediatr Orthop B"},{"issue":"9","key":"ref16","doi-asserted-by":"publisher","first-page":"363","DOI":"10.5435\/JAAOS-D-19-00349","article-title":"Salvage Treatment Options for Painful Hip Dislocations in Nonambulatory Cerebral Palsy Patients","volume":"28","author":"Shaw KA","year":"2020","unstructured":"Shaw KA, Hire JM, Cearley DM. Salvage Treatment Options for Painful Hip Dislocations in Nonambulatory Cerebral Palsy Patients. JAAOS - J Am Acad Orthop Surg. 2020;28(9):363. 10.5435\/JAAOS-D-19-00349.","journal-title":"JAAOS - J Am Acad Orthop Surg"},{"issue":"8","key":"ref17","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1302\/0301-620X.91B8.21808","article-title":"Autologous capping during resection arthroplasty of the hip in patients with cerebral palsy","volume":"91","author":"Egermann M","year":"2009","unstructured":"Egermann M. Autologous capping during resection arthroplasty of the hip in patients with cerebral palsy. J Bone Joint Surg Br. 2009;91(8):1007\u201312.","journal-title":"J Bone Joint Surg Br"},{"issue":"12","key":"ref18","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.3390\/children8121105","article-title":"Radiological outcomes of femoral head resection in patients with cerebral palsy: a retrospective comparative study of two surgical procedures","volume":"8","author":"Horsch A","year":"2021","unstructured":"Horsch A. Radiological outcomes of femoral head resection in patients with cerebral palsy: a retrospective comparative study of two surgical procedures. Children. 2021;8(12):1105.","journal-title":"Children"},{"issue":"9","key":"ref19","doi-asserted-by":"publisher","first-page":"2139","DOI":"10.1007\/s00402-021-03833-z","article-title":"Analysis of perioperative outcomes in hip resection arthroplasty","volume":"142","author":"Nazemi AK","year":"2022","unstructured":"Nazemi AK, Upfill-Brown A, Arshi A, et al. Analysis of perioperative outcomes in hip resection arthroplasty. Arch Orthop Trauma Surg. 2022;142(9):2139\u201346. 10.1007\/s00402-021-03833-z.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"5","key":"ref20","first-page":"555","article-title":"Outcome of Girdlestone\u2019s resection arthroplasty following complications of proximal femoral fractures","volume":"72","author":"Sharma H","year":"2006","unstructured":"Sharma H, Kakar R. Outcome of Girdlestone\u2019s resection arthroplasty following complications of proximal femoral fractures. Acta Orthop Belg. 2006;72(5):555\u20139.","journal-title":"Acta Orthop Belg"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/s13037-020-00237-7","article-title":"Risk factors for pressure ulcers from the use of a pelvic positioner in hip surgery: a retrospective observational cohort study in 229 patients","volume":"14","author":"Ueno T","year":"2020","unstructured":"Ueno T, Kabata T, Kajino Y, et al. Risk factors for pressure ulcers from the use of a pelvic positioner in hip surgery: a retrospective observational cohort study in 229 patients. Patient Saf Surg. 2020;14:14. 10.1186\/s13037-020-00237-7.","journal-title":"Patient Saf Surg"},{"issue":"4","key":"ref22","doi-asserted-by":"publisher","first-page":"e239884","DOI":"10.1136\/bcr-2020-239884","article-title":"Functional outcomes of an adult with osteogenesis imperfecta after rehabilitation post bilateral Girdlestone procedure","volume":"14","author":"Supnet I","year":"2021","unstructured":"Supnet I, Abiera JE, Alcausin MML, Sumpaico CE. Functional outcomes of an adult with osteogenesis imperfecta after rehabilitation post bilateral Girdlestone procedure. BMJ Case Rep. 2021;14(4):e239884. 10.1136\/bcr-2020-239884.","journal-title":"BMJ Case Rep"},{"issue":"3","key":"ref23","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1016\/j.jos.2018.01.014","article-title":"Total hip arthroplasty following Girdlestone arthroplasty","volume":"23","author":"Ikebe S","year":"2018","unstructured":"Ikebe S, Sonohata M, Kitajima M, Kawano S, Mawatari M. Total hip arthroplasty following Girdlestone arthroplasty. J Orthop Sci Off J Jpn Orthop Assoc. 2018;23(3):532\u20137. 10.1016\/j.jos.2018.01.014.","journal-title":"J Orthop Sci Off J Jpn Orthop Assoc"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/www.researchsquare.com\/article\/rs-10695380\/v1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.researchsquare.com\/article\/rs-10695380\/v1.html","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T04:53:23Z","timestamp":1789361603000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.researchsquare.com\/article\/rs-10695380\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":23,"URL":"https:\/\/doi.org\/10.21203\/rs.3.rs-10695380\/v1","relation":{},"subject":[],"published":{"date-parts":[[2026,9,14]]},"subtype":"preprint"}}