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Year : 2017  |  Volume : 5  |  Issue : 3  |  Page : 106-109

Indications of total hip arthroplasty at a tertiary hospital in Jeddah

Department of Orthopedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia

Date of Web Publication6-Nov-2017

Correspondence Address:
Amre Sami Hamdi
Department of Orthopedic Surgery, King Abdulaziz University, Jeddah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ssj.ssj_24_17

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Objectives: The aim of this study is to determine the indications of primary total hip arthroplasty (THA) at a tertiary hospital in Jeddah, Saudi Arabia.
Methods: The electronic medical records system (Phoenix) of the hospital was searched for all registered patients who had undergone THA between 2001 and 2015. The research team reviewed patients' files, X-rays and collected data, including patients aged at the time of surgery, procedure year, site, and presurgical diagnosis.
Results: A total of 107 patients had undergone THA during the study. Gender-specific prevalence was 50.5% in females and 49.5% in males; the average age of the patients was 52 years. Of the 107 patients, only 15% had bilateral surgery, and 46.7% of the 85% who had unilateral THA had surgery on the left side. The main indication of surgery included primary hip osteoarthritis (OA) (43.9%), avascular necrosis (25.2%), posttraumatic arthritis (22.4%), developmental dislocation of the hip (5.6%), hip ankylosis (1.9%), and postinfection arthritis (0.9%).
Conclusions: The rate of THA at our institution increased through between 2001 and 2015; approximately, 66.4% of surgeries were performed during the last 7 years. OA was the most common indication of surgery during the study.

Keywords: Etiology, hip arthroplasty, hip replacement surgery

How to cite this article:
Hamdi AS, Bakhsh DM, Al-Sayyad M. Indications of total hip arthroplasty at a tertiary hospital in Jeddah. Saudi Surg J 2017;5:106-9

How to cite this URL:
Hamdi AS, Bakhsh DM, Al-Sayyad M. Indications of total hip arthroplasty at a tertiary hospital in Jeddah. Saudi Surg J [serial online] 2017 [cited 2018 Dec 11];5:106-9. Available from: http://www.saudisurgj.org/text.asp?2017/5/3/106/217743

  Introduction Top

Orthopedic procedures have allowed surgeons to improve the quality of life by reducing pain and restoring function in patients with musculoskeletal conditions. Total hip arthroplasty (THA) is one of the well-recognized examples of successful orthopedic interventions performed nowadays in patients with hip pain due to a variety of conditions, and it has promising outcomes in the treatment of end-stage hip disease.[1],[2]

Multiple studies have documented a significant steady increase in the number of THAs performed since its development in the early 1960s.[2],[3],[4],[5],[6],[7] The success of THA, in addition to the increased demand of a growing aging population, has produced a commensurate increase in its rate of use,[1] which can attribute to a change in the selection criteria of patients eligible to have the surgery.[2],[4]

Looking into the importance of activities of daily living and the level of symptoms, different indication criteria for THA have been generally applied. Pain at rest, pain with activity, and functional limitations were the most important criteria for THA, although the range of motion and radiographic changes were of least importance.[6],[8] By means, any condition affecting the normal smooth hip function and structure as a “ball-and-socket” joint can lead to deterioration of the joint, which can lead to deformity, pain, and loss of function. These conditions include osteoarthritis (OA), inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, spondyloarthropathies, etc.,), developmental dysplasia, childhood hip disorders (Legg-Calve-Perthes disease, slipped capital femoral epiphysis, etc.,), trauma, neoplasms and osteonecrosis.[9],[10],[11]

THA is a common orthopedic procedure. However, detailed epidemiological data on the frequency of hip replacement surgeries are unavailable, especially in Middle East countries.[4],[12] The purpose of this study is to determine the number of THAs performed at a tertiary hospital in Jeddah, Saudi Arabia and the primary indication of these surgeries.

  Methods Top

Study subjects

The Research Ethics Committee of the hospital granted ethical approval for this cross-sectional study in May 2013 (reference number 1153-13). Patients were included in this study provided they had undergone THA. A list of file numbers of the patients (THA procedure code number, 49318-00) was provided by the statistical office of the hospital. Primary radiographs were reviewed and validated data were collected by the research team from Phoenix, the hospital information system software, between 2001 and 2015. Based on the literature, the data collected included patients' age, procedure year, site, and presurgical diagnosis.

Statistical analysis

The data were analyzed using the Statistical Package for Social Sciences (IBM SPSS, New York, USA), version 22.0. Simple descriptive statistics were used to define the characteristics of the study variables. Results are expressed as counts and percentages for categorical and nominal variables whereas continuous variables are presented as means and standard deviations. The Chi-square test was used to establish the relationship between categorical variables. One-way ANOVA, with a least significant difference as a post hoc test, was used to compare more than two groups. These tests were done with the assumption of normal distribution. Finally, a conventional P < 0.05 was used to reject the null hypothesis.

  Results Top

A total of 107 patients had undergone THA at our institution between 2001 and 2015. The mean age of the sample was 58.3 ± 20.2 years (range, 12–96 years), with most patients belonging to the 36–55 and 56–75 years age group [Table 1]. Males comprised approximately half of the sample (49.5%). The highest frequency of procedures was documented in 2009, with a total of 16 hip replacement surgeries performed, followed by 13 in 2015 [Figure 1]. Approximately, 66.4% of the total number of THA cases performed during the study were in the last 7 years (2009–2015).
Figure 1: Rates of total hip arthroplasty between 2001 and 2015

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Table 1: Clinical and demographic characteristics of the sample

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Patients > 75 years were more likely to have THA for OA as opposed to those aged 36–55 years, who were most likely to have THA for ankylosis or avascular necrosis (AVN) (P< 0.001), [Table 2]. Based on gender, men were more likely to have hip surgery for OA or AVN as opposed to women were more likely to have THA for ankylosis or developmental dislocation of the hip (DDH) (P = 0.002). Similarly, significant differences were found with respect to the site, with the greatest proportion of patients having left hip surgery for OA (P = 0.005).
Table 2: Indication of arthroplasty categorized by age, gender, and site

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A significantly higher proportion of patients had THA due to arthritis compared with those who had ankylosis, AVN, or developmental dislocation (P< 0.001); ankylosis was documented as the least frequent indication for THA [Table 3]. Furthermore, patients who had OA were significantly older than those who had ankylosis, AVN, or DDH at the time of surgery (P< 0.001), [Table 3].
Table 3: Frequency of cases and mean age of patients by primary indication

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  Discussion Top

Data from arthroplasty registries can provide a crucial contribution to the development of arthroplasties and quality control, allowing assessment of the number and epidemiology of procedures, rate of revision, and corresponding causes of failure.[4],[13] To the best of our knowledge, no detailed public epidemiological data on the primary frequency of THA are available in the Kingdom of Saudi Arabia. In this study, we aimed to determine the number of primary THA performed at a tertiary hospital in Jeddah and the indications of the procedure at our institution.

We found that between the 2001 and 2015, a total of 107 hip surgeries had been performed at our hospital. During the last 7 years (2009–2015), 66.36% of hip surgeries were performed at our institution, which is consistent with global reports that cite an increase in the number of THAs performed.[1],[2],[3],[4],[5],[6],[7] In 67.3% of all the cases that underwent THA, OA was reported as the main indication. Similarly, other authors reported OA was the most common indication for THA, regardless of the underlying etiology, age, and gender.[8],[9],[10],[11],[12]

Contrary to another study conducted earlier at our institution, we found that a greater proportion of patients had primary hip OA than posttraumatic hip arthritis. In our study, primary OA and posttraumatic arthritis were documented in 43.9% and 22.4% of the patients, respectively versus 9.2% and 50.0% reported by the other authors.[14] This difference can be due to the growing aging population in Jeddah and in Saudi Arabia in general or the fact that our data were solely obtained from the hospital information system software, which was relatively new and did not yet have all the data for the previous years uploaded; in addition, no paper files were included or reviewed as in the previous study.

In this study, AVN was the second (25.2%) most common indication of THA contrary to the findings of another study conducted in Taiwan, where it was reported that AVN was the most common indication of primary THA (46.9%).[15] However, in line with our results, the authors also reported a male preponderance among patients with AVN. On the other hand, another study conducted among Asian patients reported that inflammatory arthritis (32.2%) was the main indication for THA.[16] Although the 2010 study at our hospital found that the rheumatoid arthritis was the main indication for THA in 7.4% of the cases, we did not document any cases of inflammatory arthritis or rheumatoid arthritis in our study.[14] On the other hand, our findings are consistent with other reports from the literature data, which identified DDH and ankylosis of the hip as a common indications for THA.[9],[10],[11],[16],[17],[18],[19]


This study has all the limitations inherent to retrospective chart reviews. In addition, the study relied only on data collected from Phoenix, the information system software of our hospital. Given that the Phoenix was relatively new, data for some years had not been completely uploaded to the system, and we did not review or include paper files. Errors may have been introduced due to human factors, either during the data collection process or radiological reviews. Moreover, the study sample is not truly representative of the overall population of patients who underwent hip arthroplasty in Jeddah and the Kingdom of Saudi Arabia.


We recommend multicenter collaborative registries to document the characteristics of arthroplasty, starting by implementing the use of standardized government clinical forms and pathways for all arthroplasties. Further, data from studies across the Kingdom of Saudi Arabia should be obtained, and these should include detailed preoperative patient characteristics, surgical approaches and technical difficulties, implant types, postoperative complications, revision rates, and indications.

  Conclusions Top

Overall, we observed an increase in the rate of THA among our patients, with 66.4% of THA cases performed during the past 7 years. The main indications of THA in our sample included primary OA compared with published studies in the literature.


First, we are grateful to God for the good health and wellbeing that were necessary to complete this research paper. We also wish to express our sincere thanks to Fanar Hakim for her help in data analysis, Adeebah Albadran for her help in data collection.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Figure 1]

  [Table 1], [Table 2], [Table 3]


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