Total Hip Arthroplasty in Challenging Settings: Acetabular Fractures, Adolescents, Conversions, and Developmental Dysplasia of the Hip.

BACKGROUND: Total hip arthroplasty (THA) is one of the most common and successful procedures for the treatment of end-stage hip arthritis. However, in certain complex scenarios, THA can present important and unique challenges, specifically following acetabular fractures in adolescent patients, following failed fixation of proximal femoral fractures, and in developmental dysplasia of the hip. As these cases involve distorted anatomy, poor bone quality, retained hardware, and previous surgeries, detailed planning, specialized instrumentation and implants, and novel surgical techniques are required.

METHODS: This narrative review examines the challenges, surgical considerations, outcomes, and complications in four complex THA scenarios.

RESULTS: Complex THA cases are associated with increased incidences of complications such as dislocation, aseptic loosening, and infection. Despite these risks, advances in surgical techniques, preoperative imaging, and implant design have contributed to improved outcomes. Successful management requires careful preoperative planning, familiarity with specialized tools and techniques, and individualized surgical strategies.

CONCLUSIONS: THA in complex settings remains technically demanding but can lead to substantial improvements in patient quality of life. Continued innovation in surgical technology and implant design is essential to reduce complications and optimize outcomes in these challenging cases.