Primary Total Hip Arthroplasty on Complex Hips Conditions in a Low-Resource Setting

Introduction: Total hip arthroplasty of complex morphology is a challenge for the orthopaedic surgeon. Careful analysis of the hip’s anatomy helps to unravel the difficulties and anticipate the procedures to be performed and the implants to be planned. The aim was to identify the types of hip that make first-line THR difficult, specify the technical procedures to be used on these sites, and assess the functional results of the series. Material and Methods: This was a retrospective study that concerned patients operated on for total hip arthroplasty between January 2015 and December 2022 at the medical center “La Grâce” in Bobo-Dioulasso, Burkina Faso. Patients with coxarthrosis (on hip dysplasia, acetabular protrusio, acetabular malunion or neurological hip) and those with ankylosis of the hip, osteonecrosis secondary to neglected dislocation of the hip or hemoglobinopathy were included. Results: A total of 31 total hip replacements were performed in 30 patients. The mean age of patients at the surgery time was 36.2 years with extremes of 17 and 61 years. The male-to-female sex ratio was 1. The main indications for THA were the dysplasic hip osteoarthritis (11 cases) and the neglected hip dislocations (7 cases). In situ femoral neck osteotomy before hip dislocation was performed in seven cases. The acetabulum reconstruction techniques varied from the structural iliac bone graft (n = 3) and cancellous bone graft (n = 4) to the Kerboull plate (n = 1). After 45 months of mean follow-up, all hips were evaluated. The mean PMA score increased from 7.1 [4 - 8] before the surgery to 13.2 [13 - 17]. Conclusion: The large spectrum of challenges in complex hip management requires effective preoperative planning. Preoperative planning minimizes complications and ensures a better outcome.

Highly cross-linked versus conventional polyethylene inserts in total hip arthroplasty,a five-year Roentgen stereophotogrammetric analysis randomised controlled trial

BACKGROUND Polyethylene(PE)particles produced by wear of the acetabular insert are thought to cause osteolysis and thereby aseptic loosening of the implant in total hip arthroplasty(THA).As highly cross-linked polyethylene(HXLPE)is presumed to give lower wear rates,in vivo studies are needed to confirm this.AIM To compare the wear of REXPOL,a HXPLE,with conventional PE within the first five years after implantation using Roentgen stereophotogrammetric analysis(RSA).METHODS Patients were randomised to receive either a HXLPE(REXPOL)or a conventional PE insert during primary THA.RSA images were obtained directly postoperative and after 6 wk,12 wk,6 mo,12 mo,24 mo and five years.Functional outcomes were assessed using the Hip Injury and Osteoarthritis Outcome Score and Harris Hip Score at baseline and five years after surgery.RESULTS The HXLPE(REXPOL)showed less wear in the latero-medial direction.Significant wear rates of conventional PE were seen in the latero-medial and center-proximal direction and in volume and corrected volume,whereas the REXPOL did not show these outcomes over time.Improvement from baseline in functional outcome did not significantly differ.CONCLUSION Total 3D wear is less in THAs inserted with a REXPOL inlay than a conventional PE inlay after five years.This study confirms,for the first,that the REXPOL HXLPE inlay is preferred to standard PE.