Introduction: Total Hip Replacement is relatively new in Nigeria and recently commenced
at the National Orthopaedic Hospital Enugu (NOHE) which is one of the three Orthopaedic
centres in Nigeria. This paper reviews constraints and challenges over the initial three and
half years at NOHE with a view to sharing local challenges via pictorial presentations of
case reports, showing solutions proffered and seeking more information on better options
to move this evolving sub specialty in our region forward for better patient care and
outcome. Methodology: A prospective analysis of 70 cases done from November 2008 till
January 2012 was done. Result: Constraints include poverty, ignorance and illiteracy
leading to late presentation with a complex primary hip which is akin to a revision hip at
presentation. Limited expertise for both the surgeons and the theatre nurses in
arthroplasty. All these alongside poorly developed infrastructure give rise to peri-operative
challenges which include prolonged operation time, excessive blood loss, delay in patient
mobilisation, implant dislocation, periprosthetic fractures and infection. Conclusion: Better
outcome will need patient education, institutional support towards provision of a wide
range of prosthesis (primary and revision), appropriate theatre facility, and capacity
building of surgeons and support staff.
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Article
Full-text available
September 2015 · The Open Orthopaedics Journal
Periprosthetic proximal femoral fractures are a major challenge for the orthopaedic surgeon, with a continuously increasing incidence due to aging populations and concordantly increasing numbers of total hip replacements. Surgical decision-making mainly depends on the stability of the arthroplasty, and the quality of bone stock. As patients final outcomes mainly depend on early mobilization, a
... [Show full abstract] high primary stability of the construct is of particular relevance. Osteosynthetic procedures are usually applied for fractures with a stable arthroplasty, while fractures with a loosened endoprosthesis commonly require revision arthroplasty. Osteoporotic bone with insufficient anchoring substance for screws poses one major concern for cases with well-fixed arthroplasties. Complication rates and perioperative mortality have remained unacceptably high, emphasizing the need for new innovations in the treatment of periprosthetic fractures. Transprosthetic drilling of screws through the hip stem as the most solid and reliable part in the patient might represent a promising future approach, with auspicious results in recent biomechanical studies. View full-text Article
Full-text available
June 2018 · SICOT-J
Introduction:
Total hip replacement (THR) surgery is still evolving in Nigeria with increasing awareness as more cases are being done. This has attraction for individuals who hitherto had no solutions for their hip pathologies. These are mostly complex primary hips which present challenging technical difficulties with increased risk of complications, thus requiring detailed planning to ensure
... [Show full abstract] successful operation. This work aims to present the pattern of complex primary hips presenting for THR, the challenges and complications.
Methodology:
Data collected over a seven year period, of patients who presented for THR, were analyzed for age, sex, diagnosis, type of hip, complications, duration of surgery, blood loss and transfusions, challenges and outcome.
Results:
Fifty-nine (43.4%) of the 136 cases of THR done were complex primary hip replacement surgeries. Avascular necrosis of femoral head amongst sickle cell disease patients (23.7%) was the commonest cause of complex primary hips in our series. Most of them had absent/tight medullary canals. This is followed by old unreduced hip dislocation and non-united hip fractures with an incidence of 10.1% each. The major peri operative complication noted was calcar split in 10 patients (16.9%) Discussion: Sickle cell disease patients presented more with complex primary hips and the commonest difficulty was recreating medullary canals. Increased operation time and blood loss alongside technical difficulties should be anticipated and measures put in place to avert complications. View full-text Article
Full-text available
December 2012 · The Journal of the Kuwait Medical Association
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-
... [Show full abstract] 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. View full-text Article
Full-text available
April 2018 · Nigerian Journal of Clinical Practice
Objective:
The aim of this study is to describe the pattern of presentation osteoarthritic patients with sickle cell disorder (SCD) in our environment, determine the implant sizes taking the peculiar nature of the pathology and our operating environment into consideration, highlight the challenges and technical difficulties encountered during the procedure, measure the functional outcome and
... [Show full abstract] observe complications of treatment, recommend ways of improving outcome.
Patients and methods:
Between November 2008 and November 2012, 29 consecutive primary total hip replacements (THRs) were performed on 21 patients with avascular necrosis of the head of femur secondary to SCD. Patients' evaluation was performed at two different times of follow-up (1 and 5 years, respectively).
Results:
Twenty-one patients were available at 1 year as well as 5-year follow-up. The mean preoperative Harris Hip Score was 20.17 ± 11. The mean postoperative Harris Hip Score was 92.25 ± 13 (P < 0.001) at 1 year and 88.75 ± 10 (P < 0.001) at 5 years. Eighteen patients had regional anesthesia while three had general anesthesia. The average cup size used was 49.43 with a range of 46-54. The average liner size was 49.43 with a range of 46-54. The head size used in all patients was 28. The average stem size was 6.57 with a range of 6-8. The offset used in all the patients was standard All the patients had 1-2 screw fixation of the acetabular shell. Four patients had complications as follows: periprosthetic fracture 1, superficial wound infection 1, pulmonary complication 1, and abdominal crisis 1.
Conclusion::
THR is a veritable means of treatment of patients with avascular necrosis of the femoral head arising from SCDs. The challenges encountered during the surgery are related to the quality of bone of the affected patient. Arthroplasty Surgeons in our environment must be fully prepared for the challenges by ensuring a preoperative plan that will take care of the technical problems such as recreating femoral canals, wiring of intraoperative fractures as well as treatment of acetabular defects. A detailed planned total hip arthroplasty can be performed in patients with SCD in younger patients with good clinical benefits. View full-text Conference Paper
Full-text available
April 2010
Background: Since 1960's after the work of Charnley and Gunston on
the hips and knees respectively, a lot of advances had been seen in this
field of orthopadics. In fact total joint replacement is regarded as the
most successful orthopedic operation overseas.
In sub-Saharan Africa, this is still an emerging field. In Nigeria, National
Orthopedic Hospital Enugu has taken a leading role in
... [Show full abstract] establishing this
sub specialty.
The objective of this paper is to present our experiences and challenges
in establishing this field.
Method: A review of forty three consecutive total joint replacement
done in this hospital from 2008 till is presented. Their demographic data,
joints affected, etiology, co-morbidities, anesthesia, post-op treatments,
complications, and follow-up was analyzed.]
Result: Forty one patients had total joint arthroplasty in 43 joints.
34(79%) were hip while 21% (9) were knees. 51% (21) were males and
49% (20) were females. Age range was 25-78, average 52 yrs.
Intractable joint pain was the commonest indication. Those who
presented within 1 year were usually trauma related and usually
rd th
younger. 60% were discharged within the 3 week, the rest in the 4
week. Usually on crutch partial weight bearing.
The follow- up is progressing with the patients at various post-op phases
ranging from 4 wks- 18months. Most patients were happy and satisfied
with their progress.
However a patient was noticed to have dislocated implant 2 months postop
while in 5 others the pedal edema is regressing.
Conclusion: Total hip and knee arthroplasties are becoming routine
procedures in this hospital. Most of our patients are younger. The results
so far are comparable with what is obtainable abroad and should reduce
need for traveling abroad to get this treatment. View full-text Article
Full-text available
September 2018 · Nigerian Journal of Clinical Practice
Background:
Acetabular reconstruction following bone loss is a major challenge facing the arthroplasty surgeon. Traditionally, the armamentarium for the treatment of large bone defects (Paprosky Type 2C or 3) included antiprotrusio cages (APC). The aim of this study is to determine the pattern of presentation and assess the early functional outcome of patients who had undergone acetabular
... [Show full abstract] reconstruction using APC in complex primary total hip replacement (THR).
Patients and method:
Between November 2008 and November 2015, 38 THR were carried out in 35 patients who required acetabular reconstruction, at Davidson and Judith Consultants Clinics Enugu, Nigeria.
Results:
There were 25 males and 10 females, with a ratio of 2.5:1. The average age of the patients was 61.33 ± 6.92 with a range of 56 to 72. The mean pre-op Harris score was 49.02 ± 2.3.The mean post-op Harris hip score (HSS) was 88.75 ± 10 (P < 0.001) at one year and 92.25 ± 13 (P < 0.001) at 5 years. The etiology showed that most (52.63%) of our patients had primary osteoarthritis with Type 3 acetabular defect. Two (5.26%) patients had the following complications: dislocation (2.63%) and screw breakage (2.63%). The minimum follow-up period was 5 years.
Discussion:
After follow-up at 1 year and 5 years, the hips showed significant improvement concerning pain, gait, and mobility based on HHS and were able to return to their various professions.
Conclusion:
APC provides a satisfactory solution for patients who present with acetabular deficiency in complex primary THR. View full-text Last Updated: 04 Jul 2022
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