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Primary complex total hip arthroplasty is defined as a patient who has got compromise in bone and soft tissue. That could be the acetabulum or the femur could be dysplastic, it could be ankylosed means it is fused because of variety of reasons and there could be something called as protrusion, that means the femoral head has gone into the pelvis. These are quite challenging to treat and also patient could have a neuromuscular condition which stops from balancing and these are the challenges one can face routinely during the primary hip replacement. Having said that, we need specialist instruments and probably we need to use a bone graft to solve the problem and get the patient into a normal alignment where a patient can live a normal day to day activity of a living.