| Popis: |
Background: Total hip arthroplasty (THA) surgery for complex primary hips are challenging not only for its technical difficulties but also for increased risk of complications, thus requiring detailed planning to ensure successful operation. This paper aims to present the pattern of complex primary hips presenting for total hip replacement and the challenges and complications. Materials and Methods: This was a retrospective study in which records of patients who had THA from 2015 to 2019 were analyzed for the demography, pattern of complex primary hip, and the surgical challenges and complications. Outcome of follow-up results was analyzed by clinical (Harris Hip Score) and radiological evaluation at 6 weeks, 3 months, and 2 years. Results: One hundred THAs were done during the study period, out of which 42 THAs in 29 patients (16 unilateral and 13 bilateral THAs) were of complex primary hip. Majority of them were of ankylosing spondylitis (38.1%) followed by posttraumatic avascular necrosis of femoral head (23.8%). The main difficulties were related to soft-tissue contracture, completely fused hip, and removal of hardware in old operated hip fracture. Postoperatively, majority of the patients had anemia (7 patients, 16.6%), followed by postoperative dislocation in 2 patients (4.7%). Outcome of follow-up results was analyzed by clinical (Harris Hip Score) and radiological evaluation at 6 weeks, 3 months, and 2 years, and the overall outcome was satisfactory in 95% of the patients. Conclusion: Complex THA is challenging and needs to assess properly and to be done meticulously. The surgical exposure and subsequent placement of components can be significant challenges in complex THA which can be tackled by using proper instrumentation and modular implants. With proper surgical technique, proper instrumentation, and proper implantation, one can expect good-to-excellent results even in complex THA. |
