Results of primary total hip replacement with special attention to technical difficulties encountered in a cohort of Saudi patients.

To illustrate our experience and the difficulty faced in primary total hip replacement (THR) in Saudi patient population.We retrospectively reviewed our database between February 2002 to December 2007 for primary THR cases at King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia and identified 58 hips (54 patients). Patients data were collected from patient's medical records, clinical examination, and x-ray films. Operative reports were examined for the difficulty encountered during surgery and was classified into femoral, acetabular, soft tissue and combined difficulties. Patients follow up was a minimum of 2 years.The indication of surgery was posttraumatic arthritis in 50%, sickle cell anemia related avascular necrosis in 16.6%, primary osteoarthritis in 9.2%, idiopathic avascular necrosis in 9.2%, rheumatoid arthritis in 7.4%, and other indications were 14.7%. The femoral obstacles included narrow femoral canal in 27.7% and proximally migrated femur in 5.5%. Acetabular obstacles included protrusio acetabuli in 14.8% and structural posterior acetabular bone defect in 5.5%. Soft tissue obstacles included tight capsule in 14.8% and muscle contracture in 11.1%.Our Saudi patient population has shown different pathology of their hip disease in which most of the hips being posttraumatic as compared to series published in the west. We advised those who intend to tackle THR in this population to perform extensive preoperative planning in order to be able to anticipate the difficulty demonstrated by our experience.