Total Hip Arthroplasty in Lubumbashi (DR Congo), Outcomes in a Resource-Limited Setting

Total hip arthroplasty (THA) is well established in high-income countries but remains challenging in sub-Saharan Africa due to limited implant availability, inadequate infrastructure, and financial constraints. This study presents a 7 year experience of THA in Lubumbashi, Democratic Republic of Congo, focusing on both clinical outcomes and the strategies developed to overcome local challenges.

We retrospectively analyzed 60 THAs performed on 58 patients (mean age 53.8 years) between 2017 and 2024 at Medpark Clinic. The main indication was femoral head osteonecrosis (71.6%), including 11 cases in patients with sickle cell disease. All procedures used a transgluteal approach, with implant choice adapted to bone quality and availability. Rehabilitation emphasized early mobilization despite limited physiotherapy resources.

At a mean follow-up of 4.5 years, functional outcomes improved markedly, with the Postel-Merle d'Aubigné score rising from 6.4 preoperatively to 16.2 at six months. Excellent or good results were achieved in 90.7% of cases. Complications occurred in 17.2% of patients, including dislocations (6.6%), infections (6.6%), periprosthetic fractures (3.3%), aseptic loosening (3.3%), one pulmonary embolism (1.6 %), and two deaths (3.3%).

Barriers included high implant costs and irregular supply, addressed through long-term supplier partnerships and flexible payment plans. Infection control limitations were mitigated by strict asepsis protocols, povidone-iodine lavage, and selective use of antibiotic-loaded cement. In the absence of formal rehabilitation centers, structured patient and family education with early weight-bearing protocols facilitated recovery. Socioeconomic barriers were partially alleviated by forfait-based pricing and community financing mechanisms.

Despite significant structural and economic constraints, THA can be safely and effectively implemented in resource-limited African settings when supported by careful surgical planning, tailored implant strategies, strict infection control, and innovative solutions to financial and logistical barriers.