Fonkoue Loïc, Muluem Kennedy Olivier, Tsiagadigui Jean Gustave, Bitjong Gregory, Nana Theophile, Umaru Chifen, Mohamadou Guemse and Jean Bahebeck
Introduction: Total hip replacements are becoming more common in our environment due to an aging population and an overall improvement in the provision of healthcare. They remain costly and at the expense of the patient, making any failure of the intervention dramatic. Early revision surgery is a devastating complication, exacerbating morbidity, mortality and cost. The aim of this study was to determine the rate of early revision of total hip replacements (THRs) in Yaounde and to describe their etiologies, indications and short-term results.
Patients and Methods: All records of patients operated for a primary THR in hospitals in Yaounde during the period from January 2015 to December 2021 were collected, and retrospectively analyzed to recruit those who had been reoperated on the same hip in the year after the first THR surgery. Data on the etiology of the revision surgeries, therapeutic indications, and results at one year of follow up were collected.
Results: Out of a total of 117 primary THRs performed during this period, 10 cases of early revision surgeries were performed, representing an early revision rate of 8.5%. The initial indications for primary THR were coxarthrosis (5 cases), osteonecrosis (3 cases) and complex hip fractures (2 cases). The etiologies of early revisions were infection in 6 (60%) cases, irreducible or uncontrollable dislocations in 3 (30%) cases, and periprosthetic fracture in 1 (10%) case. The therapeutic indications were debridement with maintenance of the implant in 2 cases, debridement with implant explantation – sterilization – then reimplantation of the same implant in 2 cases, debridement and exchange of the implant in 2 cases, open reduction with repositioning of the acetabulum in 3 cases, and osteosynthesis by cerclage wiring in 1 case. The immediate results were favorable in 3 (30%) cases, while 4 required a second revision surgery. The functional evaluation at one year follow up which was assessed using the Postel-Merle d’Aubigné (PMA) score was 11.5 [7-15].
Conclusion: The rate of early revision surgery of primary THR remains relatively high in our environment, when compared to developed countries. Infections and hip joint instabilities are the main etiologies. Their management deserves to be improved in order to optimize the results in this setting.
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