Manasse H, Daoulas T, Rohimpitiavana AS, Solofomalala GD, Dubrana F, Razafimahandry HJC. Surgical techniques and outcomes of difficult total hip replacements: A challenge in a low-income country. World J Orthop 2025; 16(7): 105111 [DOI: 10.5312/wjo.v16.i7.105111]
Corresponding Author of This Article
Herijaona Manasse, MD, Service de Chirurgie Orthopédique et Traumatologique, CHU Joseph Ravoahangy Andrianavalona, Route Nationale 1, Antananarivo 101, Madagascar. herijaona.mrakotoherisoa@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jul 18, 2025; 16(7): 105111 Published online Jul 18, 2025. doi: 10.5312/wjo.v16.i7.105111
Surgical techniques and outcomes of difficult total hip replacements: A challenge in a low-income country
Herijaona Manasse, Thomas Daoulas, Amboara S Rohimpitiavana, Gaëtan Duval Solofomalala, Frederic Dubrana, Henri Jean-Claude Razafimahandry
Herijaona Manasse, Amboara S Rohimpitiavana, Henri Jean-Claude Razafimahandry, Service de Chirurgie Orthopédique et Traumatologique, CHU Joseph Ravoahangy Andrianavalona, Antananarivo 101, Madagascar
Thomas Daoulas, Frederic Dubrana, Service de Chirurgie Orthopédique et Traumatologique, CHU Brest Boulevard Tanguy Prigent, Brest 29200, France
Gaëtan Duval Solofomalala, Service de Chirurgie Orthopédique et Traumatologique, CHU Anosiala, Alakamisy 105, Madagascar
Co-corresponding authors: Herijaona Manasse and Thomas Daoulas.
Author contributions: Manasse H and Daoulas T designed and conducted the study and wrote the paper; Rohimpitiavana AS, Solofomalala GD, and Razafimahandry HJC supervised the study; Dubrana F was responsible for the analysis; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board.
Informed consent statement: Informed consent was obtained from all subjects involved in the study.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Herijaona Manasse, MD, Service de Chirurgie Orthopédique et Traumatologique, CHU Joseph Ravoahangy Andrianavalona, Route Nationale 1, Antananarivo 101, Madagascar. herijaona.mrakotoherisoa@gmail.com
Received: January 13, 2025 Revised: April 13, 2025 Accepted: June 7, 2025 Published online: July 18, 2025 Processing time: 187 Days and 0.1 Hours
Abstract
BACKGROUND
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.
AIM
To describe the results and difficulties encountered following difficult THR in the study center.
METHODS
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.
RESULTS
At last follow-up, functional results were considered good to excellent according to the Postel-Merle d'Aubigné score, with significant improvement after surgery (P < 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%.
CONCLUSION
Even in difficult conditions, THR can produce favorable results through careful planning, adaptation of techniques and targeted approaches to overcoming challenges.
Core Tip: Difficult total hip replacement is all the more of a challenge in a developing country, due to the difficulty of surgery, the lack of equipment and the limited availability of implants. However, adapting techniques could greatly improve functional results for patients long handicapped by underlying pathologies, in most cases evolving since childhood.
