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

Abstract

Introduction: 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. Materials and Methods: 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. Results: 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%). Challenges and solutions: 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. Conclusion: 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.