Abstract: Background: The purpose of this study was to evaluate the complications of primary total hip arthroplasty (THA) in a low-income country, as well as their management and outcome.
Patients and Method: We conducted a retrospective cohort study on 130 consecutive primary total hip arthroplasty (THA) procedures performed across five institutions in Yaounde from January 2018 to December 2022. Patients were contacted for an ultimate evaluation, and all individuals who provided informed consent were included in this study. Our investigation focused on complications occurring perioperatively or during the follow-up period. All medical records were reviewed specifically for the management of complications and outcomes. Complications were defined as any problem requiring additional therapeutic intervention. A total of 105 patients were included in the analysis; the mean age at the time of surgery was 60±16.2 years, with 53 (50.4%) being male.
Results: Major complications were observed in 15 patients, resulting in a prevalence of 14.28%. The main intraoperative complication was peri-prosthetic fracture, found in 9 (8.6%) cases. Early postoperative complications included surgical site infections (SSI) in 9 cases (8.6%), dislocations in 8 cases (7.6%), pulmonary embolism in 2 cases (1.9%). Late complications primarily included chronic prosthetic joint infections (PJI) in 4 (3.8%) cases, aseptic loosening in 4 (3.8%) cases, and peri-prosthetic fractures in 2 cases (1.9%). The mortality rate during the follow-up period was 3.8%. Periprosthetic fractures were treated with cerclage, tension band wiring, plate and abstention, resulting in bone healing in all cases. Hip dislocations were treated with open reduction in all cases; all attempts at close reduction were unsuccessful. SSIs were treated with surgical revision in 7 cases (of whom implant retention in 2 cases, implant exchange in 2 cases and implant sterilization in 3 cases). Four cases of relapse of infection were observed, leading to chronic PJI, which were treated with a Girdlestone procedure in 3 cases. All sciatic nerve palsies evolved favorably, with total recovery after the first postoperative year. The overall functional score (average PMA score) at the last follow-up was 13.2±1.7 [range 8-17] and 84% of patients reported satisfaction or high satisfaction levels.
Conclusion: The prevalence of major complications related to hip arthroplasties in Yaounde, although still high compared to Western literature, has shown slight improvement compared to previous series in the same environment Apart from PJIs, where therapeutic indications and outcomes need thorough improvement, the treatment of hip arthroplasty complications in Yaounde generally yields satisfactory results.
