Causes of Primary Total Hip Arthroplasty Revision in Sub-Saharan Africa: A Single-Center Series from Idrissa Pouye General Hospital, Senegal

Introduction: Total hip arthroplasty (THA) is a highly effective procedure, but the increasing number of implants and patient life expectancy have led to a rise in revision surgeries. This study aims to identify and analyze the causes of THA revision within our orthopedic department in Dakar. Materials and Methods: This was a retrospective study conducted over an 11-year period. All patients who underwent revision THA were included. Fractures were assessed using the Vancouver classification and bone loss was evaluated using the SOFCOT and Paprosky classifications. Results: Thirty cases were analysed. Aseptic loosening was the leading cause of revision (46.67%), with an average onset of 10 ± 8 years post-implantation. These loosenings were predominantly bipolar (80%), characterised by significant bone loss and primarily classified as SOFCOT type 2 and Paprosky grade 2A. Prosthetic instability (dislocation) was the second most common cause of failure (26.67%). Periprosthetic fractures accounted for 13.33% of cases and were all classified as Vancouver type B2, indicating an unstable femoral stem. Other causes included material wear/breakage (6.67%) and septic loosening (3.33%). Conclusion: In our practice, aseptic loosening and instability are the primary drivers of THA revision. Improving long-term outcomes will require more rigorous primary surgical techniques, advanced implants such as dual-mobility cups for high-risk patients and thorough radiological follow-up to detect mechanical failures before significant bone loss occurs.