Total hip arthroplasty in sickle cell disease patients in a developing country.

BACKGROUND: Osteoarthritis secondary to osteonecrosis of the femoral head is a common presentation in patients with sickle cell disease. Functional limitations with or without deformities from these complications of sickle cell disease often require Total Hip Arthroplasty (THA) to improve outcome. AIM: The aim of this study was to evaluate the postoperative outcome of THA for secondary osteoarthritis from osteonecrosis of the head of the femur in patients with sickle cell disease. Methodology: A retrospective study of outcome of THA in sickle cell disease patients between January 2010 and December 2015 is presented. Primary outcome was measured using the rates of complications and the Harris Hip scores at 6 weeks, 12 weeks, 6 months, and yearly. RESULTS: A total of 68 THA in 56 patients with sickle cell disease was reviewed. The age range was 13-68 years, with a mean of 30.9 years. There were 15 males and 41 females (M: F ratio = 1:3). Approaches to the hip were direct lateral (64.3%), anterolateral (1.8%), and posterior (33.9%). 12 (21.4%) patients had bilateral total hip arthroplasty, and 44 (78.6%) had unilateral total hip arthroplasty. No patient required adductor tenotomy. Superficial surgical site infection was recorded in 7 (12.5%) patients. The postoperative functional outcome, measured by the Harris Hip score, was good or excellent in all patients, except 2 (2.9%) who required revision surgery following unacceptable results after primary hip arthroplasty. CONCLUSION: THA is a viable and effective treatment modality for sickle cell disease patients with osteonecrosis and secondary hip osteoarthritis. The choice of surgical approach does not affect the outcome.

Subvastus versus Medial Parapatellar Approach in Primary Total Knee Replacement: An Assessment of Early Function.

BACKGROUND: Total knee replacements are increasingly being carried out for the arthritic knee. This procedure is constantly being improved upon in order to improve outcome. There is currently no consensus of the best surgical approach for primary total knee arthroplasty. This study aims to test the hypothesis that the subvastus approach has significantly better early functional outcomes compared to the medial parapatellar approach. STUDY DESIGN: Patients with bilateral knee arthritis who met the inclusion criteria were randomised into either the subvastus or medial parapatellar approach over a twelve month period. All patients had the same prosthesis inserted by one surgeon. Primary outcome measures were the Knee Society Score (KSS) at six (6) weeks post-operatively and evaluation of postoperative pain using the Visual Analogue Score (VAS) on the 2nd and 5th postoperative day. Secondary outcomes included blood loss and transfusion requirements. RESULTS: Twenty-four knees recruited with 11 knees in the subvastus and 13 in the medial parapatellar group. Results showed a significantly lower postoperative pain in the subvastus group versus the medial parapatellar group (2.8 versus 4.62 p < 0.05). Transfusion requirements for subvastus group was half that needed for the medial parapatellar group; this however was not statistically significant. Evaluation of knee score at six weeks did not show any difference in outcome (80.8 versus 84.27 p > 0.05). CONCLUSION: Post-operative pain is significantly reduced in the subvastus group, however short term knee function is not affected by surgical approach.

An evaluation of intra-operative and post-operative blood loss in total knee arthroplasty at the National Orthopaedic Hospital, Lagos.

Background: Total knee replacement is a rewarding and reliable procedure, producing a lasting relief to severe knee pains. However, significant blood loss usually in the post-operative period may be a challenge, necessitating prompt restoration of circulating blood volume to minimize morbidity and mortality. The aim of this study was to evaluate blood loss after total knee replacement. Patients and Methods: A prospective study of blood loss after Total Knee Arthroplasty in 53 patients in the National Orthopaedic Hospital, Lagos. Consecutive patients with established indications, presenting for total knee arthroplasty were recruited into the study after obtaining their consent. Results: The mean intra-operative blood loss was 342.4 mls, with a range of 50 - 1500 mls. The mean post-operative blood loss and total blood loss were 603.6 mls and 940.3 mls respectively, showing a strong positive correlation (r = 0.884, p < 0.01). The average pre-operative and post-operative haemoglobin concentration were 12.5 ± 1.2 g/dl and 9.8 ± 0.9 g/dl, respectively. The mean haemoglobin loss was 2.6 ± 1.2 g/dl (r = 0.46, p < 0.001). Conclusion: Post-operative blood loss as measured by suction drainage, is a good predictor of total blood loss, showing a strong and positive correlation.

A Review of Total Hip Arthroplasty and Post-Operative Functional Hip Scores in National Orthopaedic Hospital,Lagos.

BACKGROUND: Hip pain that severely limits functional activity, and unresponsive to other measures of treatment is the major indication for Total Hip Arthroplasty. Hip scores are used to access functional outcome, by comparing pre-operative and post-operative scores. STUDY DESIGN: The aim of this study was to investigate the overall functional outcome after Total hip Arthroplasty, and compare results between two approaches to the hip (Direct lateral and Posterior approach). A retrospective study of 56 total hip arthroplasty between January 2011 and September 2013. Pre-operative and Post-operative functional hip scores were assessed using the Harris Hip Score. Functional and clinical outcome of surgery was compared between two approaches to the hip. RESULTS: Approach to the hip was 61% for direct lateral and 39% for posterior approach. Superficial surgical site infection was recorded in 10 cases, 7 of these were in patients who had direct lateral approach. Post-operative HIP Score was excellent in 41%, and good in 52% of cases with a mean assessment at 6 weeks. CONCLUSION: The post-operative functional status, measured by the Harris Hip score, was satisfactory in over 90% of cases. There was no statistically significant difference in Harris Hip Scores in the two approaches (p>0.05).