Treatment Outcomes of Total Hip Arthroplasty Following Hip Joint Gunshot and Shell Fragment Injuries: Insights From a Single-Center Retrospective Study in Yemen

Background Gunshot injuries to the hip joint are uncommon extremity injuries. The management outcomes of total hip arthroplasty for such injuries are inadequately documented and lack comprehensive treatment protocols. The purpose of this study was to evaluate the outcomes and complications associated with total hip arthroplasty following gunshot and shell fragment injury incidents in a resource-limited setting. Materials and methods A retrospective study of 10 patients diagnosed with hip joint gunshot and shell fragment injuries and who underwent total hip arthroplasty was conducted between November 2020 and November 2023 at the 48 Model Hospital in Sana'a, Yemen. Clinical demographic data, hip joint injury characteristics, management, complications, and outcomes were collected and analyzed. The primary end measure was the Harris Hip Score (HHS), which was calculated both before and after surgery, and the secondary outcome was the variables associated with complications. Result The mean age was 30.2 ± 10.7 years (range: 20-49 years). The mechanism of injury was bullets in six (60.0%) patients and shell fragments in four (40.0%). The most common previous surgery was wound debridement in eight (80.0%) patients. The mean time between fracture and total hip arthroplasty was 16.7 ± 7.5 months. The mean preoperative and postoperative HHS was 32.1 ± 8 and 69.2 ± 16.7 points, respectively. The postoperative HHS improved significantly, with a mean difference of 37.08 points (95% CI: 24.30-49.85, p = 0.002). Complications occurred in two patients (20.0%), including heterotopic ossification in one patient and surgical site infection in one. Within a mean follow-up time of 31.9 ± 11.8 months, the functional result showed poor functional outcomes in four (40.0%) patients, fair in three (30.0%), excellent in two (20.0%), and good in one (10.0%). Factors associated with postoperative complications were older age (p = 0.049), previous abdominal surgery with intestinal repair (p = 0.022), and shorter time to arthroplasty (p = 0.029). Conclusion In this study, total hip arthroplasty was a highly effective therapy for posttraumatic arthritis induced by bullets or shell fragments, lowering discomfort and increasing function, allowing younger patients to lead normal lives. Moreover, post-arthroplasty complications were found to be more common in patients aged older, who had previous abdominal surgery with intestinal repair, and those who underwent arthroplasty earlier.