Complex primary hips for total hip replacement surgery at a tertiary institution in Nigeria

Introduction: Total hip replacement (THR) surgery is still evolving in Nigeria with increasing awareness as more cases are being done. This has attraction for individuals who hitherto had no solutions for their hip pathologies. These are mostly complex primary hips which present challenging technical difficulties with increased risk of complications, thus requiring detailed planning to ensure successful operation. This work aims to present the pattern of complex primary hips presenting for THR, the challenges and complications. Methodology: Data collected over a seven year period, of patients who presented for THR, were analyzed for age, sex, diagnosis, type of hip, complications, duration of surgery, blood loss and transfusions, challenges and outcome. Results: Fifty-nine (43.4%) of the 136 cases of THR done were complex primary hip replacement surgeries. Avascular necrosis of femoral head amongst sickle cell disease patients (23.7%) was the commonest cause of complex primary hips in our series. Most of them had absent/tight medullary canals. This is followed by old unreduced hip dislocation and non-united hip fractures with an incidence of 10.1% each. The major peri operative complication noted was calcar split in 10 patients (16.9%) Discussion: Sickle cell disease patients presented more with complex primary hips and the commonest difficulty was recreating medullary canals. Increased operation time and blood loss alongside technical difficulties should be anticipated and measures put in place to avert complications.