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

December 2012
KUWAIT MEDICAL JOURNAL 294
was slow. They were discharged on partial weight
bearing with bilateral axillary crutches.
Follow up is on-going. Harris hip score at six
months and one year post surgery improved to 90 in
thirty five patients and 80 - 89 in seventeen patients.
Most of them were satisfied with their progress so far.
There was no mortality recorded.
DISCUSSION
Total joint replacement is a well-established
procedure for the hip joint in the developed world.
Although other joints have been replaced with variable
outcome, hip replacement has been adjudged the most
successful orthopedic operation [1] .
In Nigeria, THR is at its infancy [4] although the first
THR in Nigeria was done in 1974. The subspecialty
could not advance due to sustained infrastructural
decay in public institutions and the huge capital
overlay made it an impossible venture for most private
practitioners. Nigeria is a country of 150 million people
with varying health needs. In this study, our patient
population was a mixed bag of primary osteoarthritis
(OA), post- traumatic secondary OA, sickle cell disease
(SCD) etc., and they were relatively young.
We found the mean age of our patients to be 52 ±
2.4 years (range 18 - 78 years) .The import of having
relatively younger patients is that many of them will
outlive their implant and require revision. It has been
shown that patients younger than 50 years at the time
of surgery have a greater chance of requiring a revision
than of dying; those around 58 years of age have a
50:50 chance of needing a revision and in those older
than 62 years the prosthesis will normally outlast the
patient. Patients over 77 years old have a greater than
90% chance of dying than requiring a revision whereas
those around 47 years are on an average twice more
likely to require a revision than die [5] . What this means
for our region is that revision surgery should develop
alongside primary arthroplasty.
Trauma is a known cause of morbidity and mortality
in people under sixty years of age. In our environment
there are many confounding factors to effective trauma
care. Topmost among them are poverty, influence
of traditional bone setters and faith healers. These
were major reasons why hip dislocations were left
unreduced for a reasonable length of time as observed
in the study (Fig. 4).
SCD is prevalent in Nigeria [6] . Children with SCD
were hitherto regarded as curse from the ‘spirit world’
and therefore were not adequately cared for. But with
better understanding and awareness of genetic basis
for this condition and improvement in their care
some are surviving into adulthood. For these young
SCD patients, development of AVN of the hip is one
of the most limiting factors in their lives in terms of
pain, level of activity, and function. We observed this
in our cases. The treatment of these young patients is
therefore, particularly important not only for socioeconomic
and humanitarian reasons, but also because
of their improved life expectancy [7,8] . The cases in this
study had severe adductor contractures. In addition,
sclerotic proximal femur made reaming very difficult
and could hardly accept anything above size 8 stem.
Those who may have this patient population must
be aware of this and make adequate arrangement for
different implant sizes.
Primary OA was a common etiological factor, but
not as common as in studies from the western world [8] .
A number of factors may be responsible for this;
Nigeria, although an oil producing country ranks low
in human development index - life expectancy is low
(47.56 years), and far below the usual age for primary
osteoarthritis; high illiteracy rate results in lack of
awareness about availability of service and low gross
Fig. 4a & b: Old unreduced hip dislocation