Published online Jul 18, 2025. doi: 10.5312/wjo.v16.i7.105111
Revised: April 13, 2025
Accepted: June 7, 2025
Published online: July 18, 2025
Processing time: 187 Days and 0.1 Hours
Difficult total hip replacements (THRs) are hip arthroplasties performed on patients with compromised or severely altered bone or soft tissue. Difficult THR indications are common in low-income countries, where access to care is often delayed. In these contexts, patients generally consult us with severe impairments that require significant technical adaptations, as well as adaptation to available resources and local conditions.
To describe the results and difficulties encountered following difficult THR in the study center.
This bi-centric retrospective study was conducted over a 10-year period (2013-2023) and included 50 patients operated on for difficult THR. The mean age of the patients was 37.8 years. Surgical difficulties were recorded from operative reports, and the strategies employed to overcome these difficulties were analyzed, taking into account the types of implants used.
At last follow-up, functional results were considered good to excellent according to the Postel-Merle d'Aubigné score, with significant improvement after surgery (P < 0.005). Mean operative time was 177 minutes (range: 90-290 minutes), with a mean blood loss of 568 mL (range: 200-900 mL). The short-term and medium-term post-operative complication rate was 6%.
Even in difficult conditions, THR can produce favorable results through careful planning, adaptation of techniques and targeted approaches to overcoming challenges.
Core Tip: Difficult total hip replacement is all the more of a challenge in a developing country, due to the difficulty of surgery, the lack of equipment and the limited availability of implants. However, adapting techniques could greatly improve functional results for patients long handicapped by underlying pathologies, in most cases evolving since childhood.