Vol 44 # 4 December 2012 - Kma.org.kw

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291 KUWAIT MEDICAL JOURNAL December 2012 Original Article Total Hip Replacement in Nigeria: A Preliminary Report Nwadinigwe Cajetan Uwatoronye, Anyaehie Udo Ego, Katchy Uchenna Amaechi National Orthopedic Hospital, Enugu (NOHE), Nigeria Kuwait Medical Journal 2012; 44 (4): 291 - 296 ABSTRACT Objectives: The first total hip replacement (THR) in Nigeria was performed in 1974. But due to infrastructural decay in public institutions, arthroplasty outcome was poor. National Orthopedic Hospital, Enugu (NOHE) - a regional trauma and orthopedic centre took the initiative in 2008. This paper presents our preliminary results and lists our challenges in establishing this service in a resource- constrained economy. Design: Prospective Setting: NOHE, Nigeria Subjects: Fifty-two patients who had primary hip arthroplasty between November 2008 and November 2010 Method: Details of demographic data, joints affected, etiology, co-morbidities, anesthesia, postoperative treatment, complications, and follow-up were recorded, analyzed and challenges noted Intervention : Total hip replacement Main Outcome Measures: Improvement in patient’s function and re-operation rate Result: Fifty-four THRs were done in fifty-two patients. Twenty nine (53.7%) patients were male. The mean age was 52 ± 2.4 years. Two patients had staged bilateral hip replacement. Twenty five (48.1%) patients had primary osteoarthritis. The commonest complaint at presentation was incapacitating hip pain. Half of the patients 26 (49.9%) had this pain for over four year. Trauma related secondary arthritis was responsible for 21 cases and old unreduced hip dislocation in five (9.6%) patients. Six patients had previous hip surgeries. Implant dislocation occurred in three (5.5%) patients. The functional status improved in all patients as shown by Harris Hip scores. Conclusion: There is an absolute need to develop arthroplasty service in Nigeria. A good number of the cases were complex primary arthroplasties. Most of the patients were relatively young and will outlive their implant. KEY WORDS: depressed economy, hip arthroplasty, Nigeria INTRODUCTION Total hip replacement (THR) is undoubtedly the most successful procedure in orthopedics [1] . It brings a new lease of life by pain relief and improvement in hip function in patients with advanced ostheoarthritis when conservative management has failed. Since the work of Sir John Charnley on the hip arthroplasty in 1960’s, a lot of advances have been seen in this field of orthopedics [2,3] . The first THR in Nigeria was performed in 1974 at the University of Nigeria Teaching Hospital, Enugu. But due to sustained infrastructural decay in public institutions, the specialty of arthroplasty was poorly developed even though indications were there. Hitherto, few patients (who could afford it) were referred abroad. This practice over the years was associated with many problems; huge capital flight, poor patient follow-up and persistent underdevelopment of the specialty. The vast majority of patients with end stage osteoarthritis (OA) were either left to live with their pain and deformity or were offered arthrodesis or excision arthroplasty. National Orthopedic Hospital, Enugu (NOHE) - a regional trauma and orthopedic training center took the initiative in 2008. To the best of our knowledge, no coordinated institutional arthroplasty center exists in Nigeria. The objectives of this paper were to present our preliminary results and to share our challenges in establishing this service in a resource- constrained economy. SUBJECTS AND METHODS This was a prospective study of 54 consecutive THRs done from November 2008 to November 2010. Details such as demographic data, joints affected, etiology, co-morbidities, anesthesia, postoperative treatment, complications, and follow-up were collected prospectively. The functional level of each patient was assessed pre and postoperatively, at six months Address correspondence to: Dr C U Nwadinigwe, FWACS (Orth), P O Box 927 Enugu, 400001, Enugu State, Nigeria. Tel: +2348037083917, E-mail: cunwadinigwe@yahoo.co.uk
December 2012 KUWAIT MEDICAL JOURNAL 292 and one year using Harris hip score. All patients had preoperative and immediate postoperative X-ray evaluation. The preoperative X-rays were classified based on Kellgren and Lawrence scale for primary osteoarthritis and Ficat and Arlet for avascular necrosis (AVN). The X-ray evaluation was repeated at three months, six months and one year follow-up as the case may be. All the operations were through anterolateral approach. The implant consisted of hydroxyapetite coated titanium femoral stem, 28 mm cobalt based alloy head and 28 mm UHMWP on metal shell (Corail Duraloc, DePuy International). All patients received prophylatic antibiotics - ceftriazone and metronidazole. Enoxaparin 40 mg daily for five days and compression bandaging were used for deep vein thrombosis (DVT) prophylaxis and the patients were mobilized on the first day post surgery. The major outcome measures were improvement in patient’s function and reoperation rate. Data analysis was done with SPSS software version 11. Descriptive statistics are provided. The study was approved by ethical committee of the hospital. Table 1: Duration of symptoms Duration of symptom Pain < 1 year Pain 1 - 3 years Pain 4 - 6 years Pain 7 - 10 years Pain > 10 years Frequency n (%) 3 (5.8) 23 (44.2) 10 (19.2) 11 (21.1) 5 (9.6) bilateral total hip replacements within three months. Twenty-nine (53.7%) were male while 25 (46.2%) were female, giving a male to female ratio of 1.2:1 (Fig. 1). Their ages ranged from 18 to 78 years with an overall mean of 52 ± 2.4 years (Table1). Twenty-four were on the left side and 30 on the right side. The most common complaint at presentation was incapacitating joint pain. About half the patients (26, 49.9%) had this pain for over four years (Table 1). Table 2: Etiology Diagnosis Frequency n (%) Primary osteoarthritis Post-traumatic fracture Unreduced dislocation Dysplastic hip Sickle cell disease with avascular necrosis of head of femur Total 25 (48.1) 16 (30.8) 5 (9.6) 2 (3.8) 4 (7.7) 52 Fig. 1: Genderwise distribution of patients RESULTS A total of 54 total hip replacement surgeries were done in 52 patients in two years. All the patients were pooled in a unit to create volume. Two patients had Twenty-five (48.1%) patients had primary osteoarthritis that had progressed to advanced stage 4 (Kellgen and Lawrence scale) (Fig. 2). Trauma related secondary arthritis was responsible for 21 (40.4%) cases with poorly managed hip fractures accounting for 16 (30.8%) cases and old unreduced hip dislocation accounting for five (9.6%) cases (Table 2). Three of the patients with poorly managed hip fractures had failed angle blade plates. A total of six patients had previous hip surgeries (Table 3). The five patients Fig. 2a, b: Bilateral severe OA hip a b
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