Resection Arthroplasty

Quick disclaimer: This article is for general education only and is not a substitute for professional medical advice, diagnosis, or treatment. Always talk with your surgeon or healthcare team about your own situation.

When joint replacement goes beautifully, it’s life-changing. When it doesn’tbecause of severe infection, major bone loss, or fragile healthsurgeons sometimes need a backup plan. That’s where resection arthroplasty comes in: a salvage procedure that trades some stability and strength for pain relief and infection control.

It’s not anybody’s first choice. No one grows up dreaming of a “flail elbow” or a hip without a formal joint. But in the right patient, resection arthroplasty can mean the difference between constant pain and the ability to sit, sleep, or move with far more comfort.

What Is Resection Arthroplasty?

Resection arthroplasty is a surgical procedure in which the damaged parts of a joint (and sometimes implants) are removed and not immediately replaced with a new prosthesis. Instead, the surgeon leaves a space that eventually fills with scar tissue, fibrous tissue, and sometimes a spacer, creating what’s often called a “pseudarthrosis” or “false joint.”

How is that different from a standard joint replacement?

• Total joint arthroplasty: Remove damaged joint surfaces and replace them with metal, plastic, or ceramic implants designed to restore near-normal mechanics.
• Resection arthroplasty: Remove the joint surfaces (and often a failed implant) and leave a gap, sometimes with a temporary spacer, focusing on pain relief and infection control rather than perfect mechanics.

Resection arthroplasty is most commonly used as a salvage option in joints such as:

• Hip (for example, the Girdlestone procedure)
• Knee (especially in stubborn periprosthetic joint infections)
• Elbow (after failed total elbow arthroplasty)
• Small joints of the hand and foot (such as metacarpophalangeal and metatarsal heads in rheumatoid arthritis)

Because it removes bone and leaves less structural support, resection arthroplasty is generally reserved for people who either cannot tolerate another big reconstruction or who have low functional demands but high levels of pain or infection risk.

When and Why Surgeons Choose Resection Arthroplasty

1. Severe or Persistent Infection

One of the most common reasons for resection arthroplasty is a deep joint infection, especially after a previous joint replacement. Infections around hip, knee, or elbow implants can be very serious. Bacteria may form biofilms on the metal surfaces, making them hard to eradicate with antibiotics alone.

In these cases, surgeons may remove the implant and surrounding infected tissue to control the infection. Sometimes this is part of a two-stage revision (remove the implant now, re-implant later). Other times, especially in patients with multiple medical problems, resection arthroplasty becomes the final treatment.

2. Massive Bone Loss or Soft Tissue Damage

If there isn’t enough bone or healthy soft tissue to safely hold another implant, a standard revision may not be possible. This can happen after multiple failed surgeries, traumatic injuries, or long-standing deformity. In those cases, resection arthroplasty is often the safest way to:

• Relieve pain
• Control infection or inflammation
• Preserve as much function as realistically possible

3. Advanced Rheumatoid Arthritis or Deforming Arthritis

In the small joints of the hand and forefoot, rheumatoid arthritis can severely damage joint surfaces and cause deformity. Resection arthroplasty of the metacarpophalangeal (MCP) joints or metatarsal heads has long been used to:

• Reduce pain
• Straighten severely deviated fingers or toes
• Improve function for gripping, walking, or wearing shoes

Here, the goal is less about heavy lifting or sports and more about daily function: being able to hold utensils, fasten buttons, or walk without constant forefoot pain.

How Resection Arthroplasty Typically Works

Step-by-Step Overview (Simplified)

1. Anesthesia and positioning: The patient receives regional or general anesthesia, and the joint is positioned so the surgeon can work safely and efficiently.
2. Exposure: The surgeon opens the joint using an incision tailored to the specific area (hip, knee, elbow, hand, etc.).
3. Removal of infected or damaged tissue: Any implants, necrotic bone, and inflamed soft tissue are removed. Thorough debridement is critical, especially in cases of infection.
4. Creation of a “resection gap”: The damaged articular surfaces (and sometimes entire bone segments) are taken out. This is what defines resection arthroplasty: there’s no immediate new implant.
5. Optional spacer placement: In some hips and knees, surgeons insert an antibiotic-loaded spacer to deliver local antibiotics and maintain some length.
6. Closure and drainage: The surgeon closes tissue layers and often places a drain to reduce fluid buildup.
7. Postoperative care: Patients may receive IV antibiotics, pain control, and early mobilization plans tailored to that joint and their overall health.

The technical details vary by joint and by patient. A resection arthroplasty in a paraplegic patient’s hip looks very different from a resection arthroplasty for a failed elbow prosthesis in a relatively active adult.

Recovery and Rehabilitation

Recovery after resection arthroplasty depends heavily on:

• Which joint was treated
• Whether infection is still being managed
• Overall health, strength, and mobility before surgery

Common elements of recovery include:

• Weight-bearing restrictions: After hip or knee resection, weight-bearing may be limited or modified for a period of time.
• Physical or occupational therapy: Therapists help patients learn new movement strategies, strengthen surrounding muscles, and use assistive devices safely.
• Pain control and swelling management: Medications, ice, elevation, and gentle movement can reduce pain and stiffness.
• Close follow-up for infection: Blood tests, wound checks, and imaging may be used to monitor healing.

“Back to normal” may not be realistic, but back to better than before often isespecially when the preoperative state involved severe pain, sepsis risk, or a nonfunctional limb.

Common Types of Resection Arthroplasty

Hip: The Girdlestone Procedure

A well-known form of hip resection arthroplasty is the Girdlestone procedure. Originally described for infections and other serious hip conditions, it is now mainly used as a salvage technique when a total hip replacement fails due to infection or when a patient is too fragile for complex reconstruction.

In a typical Girdlestone procedure, the surgeon removes the femoral head and neck (and any infected prosthesis if present). This eliminates the ball part of the ball-and-socket joint. Over time, scar tissue develops in the gap, and the surrounding muscles and soft tissues adapt.

What patients can expect after a Girdlestone:

• Shorter leg on the operated side
• Often a limp and need for a cane, walker, or crutches
• Improved pain control and infection management in many cases

For non-ambulatory patients (such as some people with paraplegia or cerebral palsy), the goal isn’t walking miles; it’s comfortable sitting, positioning, and hygiene. For frail older adults, the main priority may be relieved pain, controlled infection, and the ability to transfer safely.

Knee: Resection Arthroplasty for Persistent Infection

In the knee, resection arthroplasty is far less common than standard revision. However, in people with severe, recurrent periprosthetic joint infection or those who cannot undergo another big surgery, resection arthroplasty (sometimes with a permanent spacer) can be considered.

Potential outcomes include:

• Better control of chronic infection
• Reduced pain, especially at rest
• Compromised stability and walking distance

It’s usually reserved for low-demand patients who value pain relief and infection control over high-level mobility.

Elbow: Resection After Failed Total Elbow Arthroplasty

The elbow is a relatively small joint with complex biomechanics. When a total elbow replacement failscommonly from infection, loosening, or fractureone salvage option is resection arthroplasty.

After a failed elbow prosthesis is removed, patients may be left with what’s called a “flail elbow”. That sounds dramatic, but many patients still achieve:

• Significant reduction in pain
• Enough stability to position the hand in space for basic tasks
• Improved ability to perform personal care and light activities

The trade-off is decreased strength, difficulty lifting heavier objects, and sometimes an unstable feeling in the joint. For someone who previously couldn’t tolerate any motion due to pain or infection, that trade may be worth it.

Hand and Forefoot: Resection Arthroplasty for Rheumatoid Arthritis

In the hand, resection arthroplasty is frequently considered for the metacarpophalangeal (MCP) joints, especially in rheumatoid arthritis. These joints help with flexing and extending the fingers and are critical for functional grip.

Goals of MCP resection arthroplasty include:

• Reducing pain from inflamed, damaged joints
• Straightening fingers that drift toward the little finger
• Improving the ability to grasp light to moderate objects

In the forefoot, resection of the metatarsal heads can help relieve painful pressure under the ball of the foot, improve shoe wear, and reduce corns and calluses. People often trade high-impact activities for the comfort of wearing normal shoes and walking around the house without sharp, constant pain.

Risks, Complications, and Trade-Offs

Resection arthroplasty is a serious operation, and like any major surgery, it carries risks. These can include:

• Infection: Ironically, even a surgery done to manage infection can carry its own infection risk. That’s why careful preparation, antibiotics, and follow-up are essential.
• Persistent or recurrent infection: Some infections are very stubborn, and complete eradication may require multiple procedures.
• Instability: With bone removed and no formal implant, joints can feel loose or “wobbly,” especially in the elbow and knee.
• Limb shortening and gait changes: Particularly after hip resection, the leg is often shorter, which can change the way a person walks.
• Weakness and limited function: Many patients can do everyday basic tasks but may not be able to perform heavy labor, sports, or high-impact activities.
• Chronic pain: Pain usually improves compared to the preoperative crisis, but some level of discomfort may persist.

The key word with resection arthroplasty is compromise. It’s less about restoring perfect anatomy and more about controlling pain and infection while allowing the best function realistically achievable.

Living After Resection Arthroplasty

Life after resection arthroplasty often involves a mix of adaptation, creativity, and support. Some common themes include:

• Assistive devices: Canes, walkers, shoe lifts, elbow supports, and adaptive tools for dressing or cooking can make daily tasks easier and safer.
• Physical and occupational therapy: Therapists help patients strengthen the remaining muscles, learn new movement strategies, and protect their joints.
• Realistic goal-setting: Instead of aiming for marathon distances, goals might include walking around the home, safely transferring, or being able to perform personal hygiene independently.
• Mental and emotional adjustment: Going from “I’ll fix this with one more replacement” to “we’re focusing on salvage and comfort” can be emotionally challenging. Counseling, peer support, and patient education can help.

Patients who do best long-term tend to be those who:

• Understand the trade-offs
• Stay engaged with their rehab team
• Use tools and devices consistently (even if they’re not thrilled about them)
• Keep up with routine medical follow-up and infection monitoring

Questions to Ask Your Surgeon About Resection Arthroplasty

If your surgeon brings up resection arthroplasty, it’s fair to have a lot of questions. Helpful questions include:

• Why is resection arthroplasty being recommended instead of another replacement?
• What are the goals of this surgery in my case? (Pain relief, infection control, sitting comfort, basic walking, etc.)
• What kind of function should I reasonably expect afterward?
• Will I be able to walk? With what devices?
• What are my risks of complications or further surgery?
• How long will I need antibiotics?
• How will this affect my independence and lifestyle?

A good surgical team will walk you through the realistic upsides and downsides, not just the ideal scenario.

Real-World Experiences with Resection Arthroplasty

Every patient’s story is unique, but certain patterns show up again and again. These aren’t specific individuals, but they reflect common journeys many people describe.

The Hip Patient Who “Just Wanted the Pain to Stop”

Imagine an older adult who has already gone through a hip replacementand then ended up battling a deep joint infection. They’ve had multiple debridements, long courses of antibiotics, and maybe even a revision, but the infection keeps returning. Walking is painful, nights are restless, and every clinic visit comes with the same anxiety: “What if this never gets better?”

For this person, a Girdlestone resection arthroplasty can feel like a turning point. Yes, the leg will be shorter. Yes, they’ll likely rely on a walker or crutches. But for many, the constant throbbing infection pain eases, fevers and chills stop, and they can finally sleep through the night. Daily life shifts from “infection crisis mode” to a more stable routine with planned support and adaptation.

On a good day, they might walk short distances indoors with a walker, sit comfortably in a favorite chair, and enjoy visits from family without constantly shifting to find a tolerable position. That may not look like a home-run hip replacementbut compared with the preoperative struggle, it can be a massive improvement.

The Person with a Failed Elbow Replacement

Now think of someone with a history of rheumatoid arthritis who had a total elbow arthroplasty years ago. At first, it helped tremendously. Over time, though, the implant loosened, or maybe it became infected. Lifting a mug or brushing teeth started to hurt. Eventually, even letting the arm hang at the side became uncomfortable.

After careful discussion, the surgeon recommends elbow resection arthroplasty. The idea of a less stable elbow is unsettlingnobody wants their arm described as “flail”but the alternative might be unrelenting pain or repeated risky surgeries.

Post-op, this patient often needs structured occupational therapy to learn how to use the arm without overloading it. Over months, many people find they can still bring their hand to their face, type on a keyboard, and perform most self-care tasks. Heavy lifting is off the table, but light daily activities are possible, and pain is markedly improved compared with the pre-op situation.

The Patient with Rheumatoid Hands Who Wants Function, Not Perfection

Resection arthroplasty is also a long-time player in managing rheumatoid arthritis in the hands and forefeet. Picture someone whose MCP joints have drifted, fingers leaning toward the little finger, joints swollen and tender. Simple tasks like holding a fork or writing more than a paragraph feel like a workout.

After surgery, including resection arthroplasty of the MCP joints, the fingers are straighter. They may not be “Instagram perfect,” but they’re more functional. With therapy and adaptive tools, many people return to writing, holding utensils, and performing small daily tasks with far less pain. Grip strength might never match that of someone without arthritis, but the quality-of-life boost can be huge.

Patients often describe a learning curvenew joints feel different, and scar tissue takes time to settle. But once they get into a rhythm with exercises and practical adaptations (like built-up handles or ergonomic pens), they’re often able to do more with less pain than before.

What These Stories Have in Common

Across hips, knees, elbows, hands, and feet, people who undergo resection arthroplasty tend to share a few common experiences:

• They’ve usually tried other options firstoften multiple surgeries or long conservative treatments.
• Their main priorities are pain relief, infection control, and basic function, not athletic performance.
• Success is defined in very personal terms: “I can sleep,” “I can shower on my own,” or “I can walk to the kitchen without unbearable pain.”
• Ongoing rehab, assistive devices, and realistic expectations make a major difference.

Resection arthroplasty is not a miracle cure, but for the right person at the right time, it can turn a “no good options” situation into a workable, livable plan.

The Bottom Line

Resection arthroplasty is a specialized salvage procedure used when standard joint replacement or revision isn’t safe or realistic. It focuses on pain relief, infection control, and basic function, accepting that strength and perfect mechanics are often sacrificed in the process.

If your surgeon discusses resection arthroplasty, it usually means your joint problem is seriousbut it also means there is still a path forward. With clear communication, thoughtful rehab, and support from your healthcare team, this procedure can help you move from constant crisis to a more stable, manageable everyday life.