Total hip replacement after gunshot hip injuries: a severity-based clinical framework-a single-centre experience

Gunshot hip injuries present major reconstructive challenges due to contamination, retained projectiles, soft-tissue compromise, and variable bone loss. Total hip replacement (THR) in this setting carries increased risks of infection, instability, and technical failure. This study evaluated the clinical and radiological outcomes of THR following gunshot hip trauma using a structured, severity-based subclassification to inform reconstructive strategy.

Thirty patients with gunshot hip injuries underwent surgical debridement followed by THR, performed as single-stage or staged procedures according to injury severity, contamination, and systemic condition. Injuries were categorized into three groups: structurally benign injuries; severe or neglected injuries with major bone or soft-tissue compromise; and complex abdominopelvic traversing injuries with visceral involvement. Reconstruction predominantly used cementless acetabular components, with selective use of long femoral stems, revision cups, dual-mobility designs, and bone grafts or porous metal augments. Clinical outcomes were assessed using the Harris Hip Score (HHS) and WOMAC index, and radiological evaluation focused on component stability and graft incorporation.

A total of 30 patients were included: 11 in Group I (structurally benign injuries), 10 in Group II (severe or neglected injuries), and 9 in Group III (complex abdominopelvic traversing injuries). At a mean follow-up of 46 ± 10 (24-72) months, the mean Harris Hip Score (HHS) was 84 ± 10 and the mean WOMAC score was 19 ± 7. Operative complexity and blood loss increased with injury severity. Two-stage THR was required in 27% of Group I, 60% of Group II, and 100% of Group III. Radiographs demonstrated stable component fixation in all hips, with complete graft or augment incorporation within 6-12 months. Postoperative complications occurred in five patients, predominantly in higher-severity groups. Functional outcomes were inversely related to injury severity.

THR after gunshot hip injury achieved satisfactory mid-term functional and radiological outcomes in this single-center cohort. Staged reconstruction and advanced implant strategies appear beneficial in managing complex and contaminated injuries. These findings are descriptive and intended to inform clinical decision-making; further studies are required for external validation.