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. 2025 Mar 6:50:66.
doi: 10.11604/pamj.2025.50.66.46467. eCollection 2025.

Challenges of total hip replacement surgery in austere settings: a case series of 158 patients operated in the Far North Region of Cameroon

Berenger Tsanga Bessala  1   2 , Cédric Dongmo Mayopa  3   4 , Lionel Kolontchang  1   5 , Gaspary Fodjeu  4 , Chifen Umaru  1   6 , Randy Buzisa Mbuku  4 , Franck Biongolo  1   5 , Daniel Handy Eone  1   6 , Jean Bahebeck  1   6
Affiliations

Challenges of total hip replacement surgery in austere settings: a case series of 158 patients operated in the Far North Region of Cameroon

Berenger Tsanga Bessala et al. Pan Afr Med J. .

Abstract

The incidence of total hip replacement (THR) surgery is on the rise in Cameroon, attributed to the growing number of practitioners, increased availability of implants, and continuous improvement in surgeons' skills. However, challenges persist, particularly in the operating environment, equipment availability, financial policies, and prevailing cultural beliefs regarding traditional medicine. This study offers a short-term review of primary hip arthroplasty activities in an austere setting of the Far North region of Cameroon. A total of 168 hip arthroplasties were performed on 158 patients at the Maroua Military Hospital over 72 months. All procedures were done by a single surgeon using the anterior Hueter approach. Data on socio-demographics, clinical and radiological findings, and intraoperative details were collected. Complications and functional outcomes were assessed at a mean follow-up of 16 months using the Postel-Merle d'Aubigné (PMA)score. The study included 111 men and 47 women, with an average age of 49.39 years. Most patients (85.45%) had low to moderate incomes, and 79.75% of surgeries were financed in two or three installments. The main indications for surgery were neglected trauma and end-stage avascular necrosis, often delayed by traditional medical practices. Intraoperative complications, mainly nerve damage, occurred in 8% of cases, while postoperative infections were seen in 8.8%. At the final evaluation, 65% of patients had good or excellent outcomes according to the PMA score. This study highlights the challenges of performing total hip replacement surgery in resource-limited settings. It suggests improving technical infrastructure and introducing progressive funding options to enhance outcomes and reduce complication rates.

Keywords: Total hip arthroplasty; humanitarian surgery; postoperative complications; resource-limited settings; traditional medicine.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
population mapping of hip arthroplasty patients in the Far North Region of Cameroon (N=187), 2024
Figure 2
Figure 2
common indications for total hip replacement: A) neglected left femoral neck fracture; B) bilateral femoral head necrosis in terminal stage; C) neglected posterior dislocation of the left hip, Maroua Military Hospital, Cameroon, 2024
Figure 3
Figure 3
bilateral total hip arthroplasty indicated for end-stage osteoarthritis: A) preoperative X-ray; B) installation on the operating table (double draping); C) enucleation of the two femoral heads; D) postoperative X-ray, Maroua Military Hospital, Cameroon, 2024
Figure 4
Figure 4
total hip arthroplasty for a neglected femoral neck fracture: A) preoperative X-ray; B) surgical wound and tubular drain; C) femoral head; D) postoperative X-ray, Maroua Military Hospital, Cameroon, 2024
Figure 5
Figure 5
intraoperative complications: A) preoperative X-ray; B) femoral stem malpositioning on the right; C) surgical revision to reposition the femoral stem, Maroua Military Hospital, Cameroon, 2024
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