Can Walking Be Possible Without a Hip Joint After Removal?

Is it possible to walk after completely removing an artificial hip joint without replacing it with a new one?

Hello Dr.
Shih, my father is 78 years old and is on dialysis.
A couple of years ago, after suffering from inflammation of a prosthetic hip joint that he had for over twenty years, he underwent debridement and subsequently had the prosthetic hip joint replaced, which led to chronic osteomyelitis, necessitating the removal of the prosthetic joint.
He then had a temporary antibiotic-impregnated prosthesis installed, which did not cause any inflammation.
However, due to my father's strong desire to walk independently, he underwent surgery to have a permanent prosthetic hip joint installed.
Unfortunately, shortly after the installation, he fell while using a cane, and about a week later, he began experiencing severe pain in his leg.
Despite regular follow-ups and emergency visits over the past three months, there has been no improvement.
Recently, he was hospitalized due to unbearable pain in his thigh and hip, and during this hospitalization, he was found to have bacteremia.
The hospital is primarily focused on addressing the infection related to the dialysis access, so the orthopedic surgeon only provided a consultation.
The surgeon indicated that my father is quite elderly and that CT and nuclear medicine scans have not revealed the cause of the pain nor any obvious signs of infection.
The recommendation was to remove the entire prosthetic hip joint and not replace it, meaning that leg would be without a joint.
The surgeon stated that this would be safer and that post-surgery, it could resolve the pain issue, allowing him to sit, support himself while walking, or use a cane, although he wouldn't be able to walk far.
Due to my work commitments and the fact that the surgeon was only providing a consultation, I was somewhat taken aback by this recommendation and forgot to ask some questions.
Could I please ask Dr.
Shih: 1.
Without a hip joint, won't the upper end of the femur directly impact the pelvic cavity when walking or standing? Won't that be very painful? Also, without a joint, won't there be a significant difference in leg lengths, making walking difficult? 2.
Is such a recommendation common in medical practice? Could this lead to more complications in the future? 3.
As a son, what would you recommend I do to help my father in this situation? Thank you very much, Dr.
Shih.

Xiao Ma, 40~49 year old female. Ask Date: 2018/01/17

Dr. Shi Guozheng reply Orthopedics

1.
You are correct, but walking is still possible with the use of assistive devices (this surgical method is called the Girdlestone operation).

2.
This approach is available; if an infection occurs and the artificial joint cannot be healed or preserved, it can be managed this way.

3.
Make a decision after discussing with family and physicians.

Reply Date: 2018/01/17

More Info

Walking without a hip joint after its removal is indeed a complex situation, especially for an elderly patient like your father. The decision to remove the hip joint and not replace it is typically made when the risks of infection or complications outweigh the benefits of having a joint. Here’s a detailed response to your questions:
1. Walking Without a Hip Joint: After the removal of the hip joint, the upper end of the femur (thigh bone) will indeed be positioned close to the pelvis. This condition is often referred to as a "Girdlestone procedure," where the hip joint is not replaced. While it may seem counterintuitive, many patients can still walk with the aid of assistive devices like crutches or walkers. The absence of a joint means that the leg will not have the same range of motion, and there may be discomfort or pain due to the bone's proximity to the pelvis. However, many patients adapt to this new way of walking, although they may experience limitations in mobility and may not be able to walk long distances.

2. Medical Rationale for This Approach: The recommendation to remove the hip joint without replacement is not uncommon in cases where there is chronic infection or severe complications. Infections can lead to significant morbidity, and if the joint cannot be salvaged, the removal can sometimes be the safest option. While this procedure can alleviate pain and prevent further complications from infection, it does come with risks of future issues, such as joint instability, muscle weakness, or changes in gait that could lead to falls. Long-term, patients may experience discomfort or pain in the surrounding muscles and joints due to altered biomechanics.

3. Supporting Your Father: As a son, your role in supporting your father through this process is crucial. Here are some steps you can take:
- Communication with Healthcare Providers: Ensure that you have open lines of communication with his healthcare team. Ask for detailed explanations about the procedure, expected outcomes, and any potential complications. It’s important to understand the rationale behind the decision to remove the hip joint.

- Rehabilitation and Physical Therapy: After the surgery, engaging in physical therapy will be essential. A physical therapist can help your father strengthen the muscles around the pelvis and thigh, improve balance, and teach him how to use assistive devices effectively.

- Home Modifications: Consider making modifications in your father’s living environment to enhance safety and mobility. This may include installing grab bars, using non-slip mats, and ensuring that pathways are clear of obstacles.

- Emotional Support: The psychological impact of losing mobility can be significant. Encourage your father to express his feelings and consider seeking counseling if he struggles with the emotional aspects of his condition.

- Regular Follow-ups: Ensure that he attends all follow-up appointments to monitor his recovery and address any new symptoms or concerns promptly.

In conclusion, while walking without a hip joint is possible, it comes with challenges. The focus should be on rehabilitation, safety, and maintaining as much independence as possible. Always consult with healthcare professionals for personalized advice tailored to your father's specific situation.

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