(iii) Surgical tactics in the difficult primary hip replacement

The term complex primary total hip arthroplasty (THA) is used when THA is performed on patients with any combination of abnormal anatomy, bone loss and compromised soft tissues. This is often as a result of the development of secondary osteoarthritis complicating an underlying primary pathology. Those most commonly associated are developmental hip dysplasia, protrusio acetabuli, skeletal dysplasias, previous fractures or surgical procedures about the hip and neuromuscular conditions, but this is by no means an exhaustive list. The importance of preoperative planning and the use of reconstructive techniques including bone grafting, as well as the use of modular and customized implants to overcome these significant surgical challenges, are discussed.