An 8-year audit of the clinical profile, surgical indications and therapeutic outcomes of total hip arthroplasty in a sub-Saharan Africa setting: a retrospective cohort study

Background: There is limited contemporary data on total hip arthroplasty (THA) in sub-Saharan Africa in an era of improvement of global surgical practice. We aimed to determine the socio-demographic characteristics, clinical presentation, surgical indications and outcomes of THA in Cameroon. Methods: This was a retrospective cohort study in which data was collected from January 1st, 2010 to December 31st, 2017. Our study setting was the Orthopedic and Traumatology Department of the National Social Insurance Fond hospital, Cameroon. The files of all patients who underwent THA in the aforementioned surgical unit were included. Variables studied were socio-demographics characteristics (age and gender), clinical characteristics [symptoms and signs, comorbidities, preoperative hip function assessed using the Postel Merle d’Aubigné (PMA) score] and radiological signs, surgical indications, types of prostheses used, and outcomes of treatment. Results: We enrolled the files of 50 patients operated for THA with a mean age of 54.8±17.1 years and 62% were males. Sixty-eight percent, 10% and 6% had a history of alcohol abuse, an accidental fall and long-term corticosteroids use. The left hip was the most affected (74%) and the main presenting complaints were hip pain (98%) and was predominantly a mechanical pain (78%). Ninety-eight percent patients had a physiologically abnormal hip preoperative based on the PMA score. The most common indications for THA were degenerative hip disorders (78%) due to femoral head necrosis and hip osteoarthritis. All the prostheses were cemented and the installation of the cement was manual. All total hip arthroplasties were performed as open surgeries mainly under combined spinal-epidural anaesthesia (63%). Globally, good treatment outcomes were satisfactory in over 90% of patients at 5 years of clinical and radiological follow-up. Conclusions: Our results suggest that THA is feasible in these low-resource settings with good results. Patients likely to undergo THA are relatively elderly adult males with degenerative left hip disorders. This should draw the attention of orthopedic surgeons for the early management of such degenerative hip arthroplasties to advert surgical management which is not completely void of complications.