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CHALLENGES OF TOTAL HIP REPLACEMENT IN WEST AFRICAN SUB REGION: THE NATIONAL ORTHOPAEDIC HOSPITAL ENUGU EXPERIENCE

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Abstract

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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