682 - Optimizing Pain Management and Mobility: A Multidisciplinary Approach Following a Rare Girdlestone Procedure for Chronic Hip Pain

The Girdlestone procedure is a rare surgical intervention involving excision of the femoral head and neck. It is a salvage procedure for intractable hip joint infections, complex fractures, or failed total hip arthroplasties. National surgical data shows that this procedure accounts for less than 0.1% of all hip surgeries annually in the United States, highlighting its status as a last-resort intervention due to advancements in hip reconstruction and arthroplasty. A 68-year-old male with severe osteoarthritis and recurrent hip infections presented with debilitating hip pain. Within six months, the patient underwent a failed bipolar replacement, total hip arthroplasty, and revision surgery. After multiple unsuccessful attempts at hip preservation, he received an extended trochanteric osteotomy and removal of the greater trochanter.

Case Description:

Postoperatively, the patient was referred to Physical Medicine and Rehabilitation for comprehensive pain management and functional rehabilitation over six months. A multimodal pain management approach was adopted, incorporating meloxicam, acetaminophen, and low-dose opioids. Physical therapy focused on strengthening periarticular muscles, improving range of motion, and using assistive devices for ambulation. Interventional procedures included ultrasound-guided nerve blocks and transcutaneous electrical nerve stimulation for adjunctive pain relief.

Discussions:

The patient showed significant improvement in pain scores and functional mobility, progressing from a non-weight bearing to a modified independent status. Despite the absence of a hip joint, adaptive strategies enabled satisfactory quality of life, with ongoing multidisciplinary support ensuring optimal pain management and mobility.

Conclusions:

The Girdlestone procedure remains a viable option for patients with refractory hip conditions. This case highlights the importance of a multidisciplinary approach in optimizing pain management and functional outcomes post-procedure to regain independence. Further studies are warranted to explore long-term outcomes and refine rehabilitation protocols for this unique patient population.