Early Outcomes of a Hip Arthroplasty Program in Rural Ethiopia

Hip arthroplasty profoundly improves quality of life. This procedure is primarily performed in the developed world by specialist surgeons and staff using sophisticated implants. Only rarely, in a few large cities, is hip arthroplasty performed in Africa. The objective of this study was to assess whether a de novo hip arthroplasty program in rural Ethiopia, at Negele Arsi General Hospital, is feasible.

This cohort study analyzed data from 132 hip replacements in a total of 116 patients, the number and type of complications, and change in hip disability and osteoarthritis outcome scores (HOOSs). Preoperative and postoperative HOOSs were compared for 68 surgeries using a paired t-test; 58 surgeries had only postoperative HOOS data.

Between September 2021 and March 2025, a total of 97 primary total hip arthroplasty (THA) and 35 hemiarthroplasty (HA) procedures were performed, 29 by an Ethiopian team alone. The mean age of THA patients was 51 years, and 26% of patients were female. The primary indication was avascular necrosis for 41% of patients and primary osteoarthritis for 38% of patients. There was a statistically significant increase in mean HOOS subscore for THA patients from 46 to 85 and in HA from 31 to 87. There was an 11.4% complication rate with 4 failed acetabular shells, 3 femoral stem fractures, 3 dislocations, 1 deep venous thrombosis, 1 death, and no infections.

It is possible to develop a hip arthroplasty program in a rural city in a developing country with outcomes that substantially improve patient quality of life. Early results of this study are promising; however, long-term follow-up and outcomes of Ethiopian-led surgeries alone are required to fully assess program success.

Level III. See Instructions for Authors for a complete description of levels of evidence.