Surgical techniques and outcomes of difficult total hip replacements: A challenge in a low-income country

Table 1 Population characteristics

Patients	Frequency (n = 50)	Percentage (%)
Age (years)
Under 35	25	50
35-60	17	34
Over 60	8	16
Sex
Male	26	52
Female	24	48
Hip disease
Childhood disease sequelae	16	32
Post-traumatic coxarthrosis	15	30
Dysplastic coxarthrosis	7	14
Ankylosis of the hip	7	14
Neglected hip dislocations	3	6
Protrusive coxarthrosis	2	4

Table 2 Difficulties and surgical techniques to overcome them

Technical difficulties	Surgical techniques to overcome difficulties	Number of patients (n = 50)	Percentage (%)
Malunion acetabular bone defect	Acetabular autologous bone graft from the femoral head	5	10
Difficulty removing material	Careful, gradual material removal: Use of adapted materials. Cementing implants	6	12
Insufficient acetabular coverage, shallow and porous neoacetabulum or paleoacetabulum, difficulty identifying the true acetabular cavity	Shelf operation and/or bone grafting ± fixation with screws. Progressive reaming until achieving a sufficiently deep acetabular cavity	7	14
Difficult or impossible hip dislocation	Initial osteotomy followed by dislocation and fragmentary removal of the femoral head ± creation of a new acetabulum if difficulty arises during the removal of the head from the acetabulum	9	18
Cavitary defect in the acetabular floor, fusion of the femoral head and acetabulum	Impaction of autogenous bone graft from the femoral head and cemented cup ± use of support rings or anti-protrusion cages if available	4	8
Proximal femoral ascent: Limb length discrepancy Narrow femoral canal	Careful and progressive hip dislocation. Small, long-stem prosthesis	12	24
Soft tissue contracture	Careful and progressive hip dissection	25	50

Table 3 Implant features

	Number of patients (n = 50)	Frequency (%)
Year of surgery
2013-2018	19	38
2019-2023	31	62
Implant type
Dual-mobility	7	14
Conventional	43	86
Fixation methods
Cemented	44	88
Uncemented	1	2
Reverse hybrid	5	10
Bearing couples
Metal-polyethylene	29	58
Ceramic-polyethylene	21	42
Support ring/anti-protrusion cage	4	8