Surgical techniques and outcomes of difficult total hip replacements: A challenge in a low-income country

Table 2 Difficulties and surgical techniques to overcome them

Technical difficulties	Surgical techniques to overcome difficulties	Number of patients (n = 50)	Percentage (%)
Malunion acetabular bone defect	Acetabular autologous bone graft from the femoral head	5	10
Difficulty removing material	Careful, gradual material removal: Use of adapted materials. Cementing implants	6	12
Insufficient acetabular coverage, shallow and porous neoacetabulum or paleoacetabulum, difficulty identifying the true acetabular cavity	Shelf operation and/or bone grafting ± fixation with screws. Progressive reaming until achieving a sufficiently deep acetabular cavity	7	14
Difficult or impossible hip dislocation	Initial osteotomy followed by dislocation and fragmentary removal of the femoral head ± creation of a new acetabulum if difficulty arises during the removal of the head from the acetabulum	9	18
Cavitary defect in the acetabular floor, fusion of the femoral head and acetabulum	Impaction of autogenous bone graft from the femoral head and cemented cup ± use of support rings or anti-protrusion cages if available	4	8
Proximal femoral ascent: Limb length discrepancy Narrow femoral canal	Careful and progressive hip dislocation. Small, long-stem prosthesis	12	24
Soft tissue contracture	Careful and progressive hip dissection	25	50