Manasse Herijaona, Daoulas Thomas, Rohimpitiavana Amboara S, Solofomalala Gaëtan Duval, Dubrana Frederic, Razafimahandry Henri Jean-Claude
Service de Chirurgie Orthopédique et Traumatologique, CHU Joseph Ravoahangy Andrianavalona, Antananarivo 101, Madagascar.
Service de Chirurgie Orthopédique et Traumatologique, CHU Brest Boulevard Tanguy Prigent, Brest 29200, France.
World J Orthop. 2025 Jul 18;16(7):105111. doi: 10.5312/wjo.v16.i7.105111.
Difficult total hip replacements (THRs) are hip arthroplasties performed on patients with compromised or severely altered bone or soft tissue. Difficult THR indications are common in low-income countries, where access to care is often delayed. In these contexts, patients generally consult us with severe impairments that require significant technical adaptations, as well as adaptation to available resources and local conditions.
To describe the results and difficulties encountered following difficult THR in the study center.
This bi-centric retrospective study was conducted over a 10-year period (2013-2023) and included 50 patients operated on for difficult THR. The mean age of the patients was 37.8 years. Surgical difficulties were recorded from operative reports, and the strategies employed to overcome these difficulties were analyzed, taking into account the types of implants used.
At last follow-up, functional results were considered good to excellent according to the Postel-Merle d'Aubigné score, with significant improvement after surgery ( < 0.005). Mean operative time was 177 minutes (range: 90-290 minutes), with a mean blood loss of 568 mL (range: 200-900 mL). The short-term and medium-term post-operative complication rate was 6%.
Even in difficult conditions, THR can produce favorable results through careful planning, adaptation of techniques and targeted approaches to overcoming challenges.
复杂全髋关节置换术（THR）是针对骨骼或软组织受损或严重改变的患者进行的髋关节置换手术。复杂THR的适应症在低收入国家很常见，在这些国家，患者往往延迟获得治疗。在这种情况下，患者通常带着严重的损伤前来咨询我们，这需要重大的技术调整，以及对可用资源和当地条件的适应。
描述研究中心复杂THR术后的结果及遇到的困难。
这项双中心回顾性研究为期10年（2013 - 2023年），纳入了50例接受复杂THR手术的患者。患者的平均年龄为37.8岁。从手术报告中记录手术困难情况，并分析为克服这些困难所采用的策略，同时考虑所使用的植入物类型。
在最后一次随访时，根据Postel-Merle d'Aubigné评分，功能结果被认为良好至优秀，术后有显著改善（<0.005）。平均手术时间为177分钟（范围：90 - 290分钟），平均失血量为568毫升（范围：200 - 900毫升）。术后短期和中期并发症发生率为6%。
即使在困难条件下，通过精心规划、技术调整和针对性的方法来克服挑战，THR也能产生良好的结果。
