How is the outcome of primary difficult total hip arthroplasty? A cross-sectional study

Introduction: Total hip arthroplasty (THA) is the most common surgery for lower extremities. Improvement in surgical technique and advancement of surgical instrumentation extended the indications for difficult THA in previously impossible to treat. Methods: 81 primary THA procedures were performed in Cipto Mangunkusumo National Hospital during the period from January 2012 to June 2017. Subjects consisted of 29 and 52 patients in the difficult and simple group, respectively. Intraoperative parameters including bleeding volume, operation time, complication rate, radiological outcome and functional outcome (Harris Hip Score) were recorded at the end of follow-up and analysed. Results: The difficult group had significantly higher bleeding volume (p < 0.001), longer operation time (p < 0.001), and higher complication rate (p=<0.012), higher than the simple group. Radiological outcome was measured by the accuracy of component orientation placement in the safe zone resulted in no significant difference between two groups (p = 0,333). Functional outcome at the end of followup in the difficult group (88.67) did not have significant difference (p = 0.080) with the simple group (91.50). Conclusions: Those with difficult hips did not have significant difference in terms of radiologic and functional outcome compared with the simple hips. It is necessary to identify each primary THA procedures whether there were any, types and levels of difficulties that would be faced intraoperatively in order to improve preoperative planning so the outcome would be optimal.