Proportion, indications and complications of complex primary total hip arthroplasty at Muhimbili Orthopaedic Institute January 2015 to December 2019

Abstract

Background Complex primary total hip arthroplasty surgeries are becoming more common in our settings. They involve hips with compromised bony and soft tissue states. These surgeries are technically demanding and may accompany several intraoperative challenges including prolonged duration of surgery as well as excessive blood loss. Neither in Tanzania nor in East Africa, the proportion and indications of complex primary total hip replacement are known. Objective: To determine the proportion and indications of complex primary THR at MOI between January 2015 and December 2019. Methodology: This was a cross-sectional retrospective hospital-based study, conducted at Muhimbili Orthopedic Institute (MOI). Records of 374 patients who underwent primary total hip replacement between January 2015 and December 2019 were reviewed. Information on socio-demographic characteristics, diagnosis, duration of surgery, and intraoperative blood loss were extracted. Data analysis was done using SPSS version 20 computer software. Results: A total of 181(48%) out of 374 patients underwent primary THA within a specified period had complex primary THA. The average age was 55 years (16 to 95 years) with the male being 100(55.25%) and females 81(44.75%). Femoral neck fractures constituted the majority 79(43.7%) of the indications of complex primary THA followed by avascular necrosis 77(42.5%) and other indications were neglected hip dislocation 9(5.0%), implant failure 8(4.4%), giddlestone 3(1.7%), bone cyst 2(1.1%), acetabular fracture 2(1.1) as well as femoral acetabular impingement 1(0.6%). Mean duration of surgery in complex primary THA was 139.96 minutes and average intraoperative blood loss was 770.58 Conclusion; Complex primary THA surgeries are frequently done in our settings. Common indications of complex primary total hip arthroplasty are femoral neck fractures and avascular necrosis. Because of altered anatomy, there is prolonged duration of surgery and increased intraoperative blood loss in complex primary THA surgeries. Detailed preoperative planning should be done to minimize the complications associated with complex primary THA.