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).

Outcome analysis of surgical treatment of Blount disease in Nigeria.

OBJECTIVE: The objective was to evaluate the results of surgery of Blount diseases using the postoperative metaphyseal-diaphyseal angle (MDA) at 2-year follow-up. BACKGROUND: The goal of surgery in Blount disease is to restore the normal configuration of the articular surface of the proximal end of the tibia in proper relationship to the mechanical axis of the limb. Our hypothesis is that patients will demonstrate significant clinical improvements following surgery and predictive models can be developed. MATERIALS AND METHODS: All patients who had surgery for Blount disease from January 2002 till December 2007 at the National Orthopaedic Hospital Lagos Nigeria and follow-up for 2 years were included. Data extracted were gender, affected limb, Blount's type, age when deformity was noted, and age at presentation, preoperative femoral tibial angle (TFA), Langenskiold score, preoperative MDA, and postoperative MDA. Linear regression was used to assess the predictive effect of selected clinical and radiographic measures on post-MDA. The model was adjusted for confounders: age deformity noted, age at presentation, affected limb, Blount's type, and gender. Variables in the adjusted model achieving significance at P < 0.05 were included in a multiple regression analysis. RESULTS: Eighty-six knees in 57 patients were included. The mean preoperative and postoperative MDA at 2 years was 34.6° ± 8.9° and 10.6° ± 4.3°, respectively. Seventy-three knees (84.9%) have correction of ≤10° with recurrence in 13 (15.1%) knees at 2 years (P < 0.001). The postoperative MDA was graded into good outcome if ≤10°. There was a significant improvement between preoperative MDA and postoperative MDA (P < 0.001). The multilinear analysis demonstrated that the preoperative MDA was a significant predictor of the postoperative MDA. The postoperative MDA was predicted with a standard error of 0.92 with the following formula: post-MDA = 1.027 + 0.404 pre-MDA. CONCLUSION: The mean postoperative MDA of 84.9% of the knees operated at 2 years was 9.4° ± 3.1° with recurrence rate of 15.1%. Postoperative MDA is a good outcome measure for surgical treatment of Blount disease and surgical correction should aim at producing post MDA ≤10°.

Profix cemented total knee replacement: a 5-year outcome review from Lagos, Nigeria.

BACKGROUND: Total knee replacement is a standard treatment for severe osteoarthritis of the knees. It is however, still a novel procedure in Nigeria. Literature on the procedure and outcome of management are sparse in Nigeria. OBJECTIVE: This study aimed at describing Total Knee prosthetic Replacement as it is practiced in National Orthopaedic Hospital, Lagos. METHODS: Data on patients treated with Total knee replacement between 2006 and 2010 were analyzed retrospectively. The standard anterior approach, with a medial parapatellar incision under pneumatic tourniquet was used in all cases. RESULTS: There were a total of 59 knees in 48 patients operated, with a female: male ratio of 5:1. Patients were in the sixth to ninth decades of life. There was a statistically significant relationship between duration of symptoms and severity of angular deformity. The average pre-operative Knee score (KS) was 27 and average function score (FS) was 43. Average duration of surgery was 126.38 minutes. Tourniquet removal after wound closure was associated with reduced intra-operative blood loss (p < 0.05). Post-operative complications included peri-prosthetic fracture (1.69%), post-operative anaemia (8.47%), superficial wound dehiscence (3.39%) and foot drop (3.39%). The mean post-operative KS and FS increased to 80 and 75 respectively. CONCLUSION: Total knee replacement, though a novel procedure in our institution is beneficial to patients with severe osteoarthritis. A long term outcome study is being planned.

Proximal tibial metaphysis: its reliability as a donor site for grafting.

BACKGROUND: The iliac crest and the proximal tibial metaphysis are the commonest sites for harvesting bone grafts. However, obtaining bone grafts from these sites may be associated with significant morbidity. OBJECTIVE: To study the pattern of complications encountered at each donor site and to determine the reliability of the proximal tibia as a donor site. METHODS: This was a prospective study of all patients who had bone graft harvested from the iliac crest or the proximal tibia at the National Orthopaedic Hospital, Lagos between January 2006 and December 2006. All consecutive patients who were to undergo bone grafting were reviewed preoperatively. Intra-operatively, the amount of blood loss and volume of graft harvested and the time taken to harvest it were noted. All intra-operative complications were also recorded. The immediate post-operative pain was assessed and any other complications at the donor sites were noted. They were followed up monthly in the outpatient clinic for six months. RESULTS: A total of 74 patients were studied. The age range was 16-72 years with a mean of 39.7 ± 12.3 years. The male:female ratio was 1.1:1. The commonest indication for cancellous bone graft was femoral fracture nonunion. Harvesting of iliac crest bone graft took a significantly longer time and was associated with more intra-operative blood loss and post-operative pain. CONCLUSION: The commonest indication for cancellous bone graft is femoral fracture nonunion. Harvesting of bone graft from the proximal tibial metaphysis is associated with less morbidity than the iliac crest.

Locked intramedullary nailing for the treatment of femoral shaft fractures: experience and result in 19 cases.

BACKGROUND: Fractures in the proximal or distal third of the femoral shaft or those with severe comminution are known to be less suitable for intramedullary nailing with Kuntscher nail. With the introduction of interlocking intramedullary nailing the problems of rotational malalignment and shortening that accompany such fractures are now less common. At the National Orthopaedic Hospital Igbobi, Interlocking Intramedullary Nailing was introduced as a form of surgical treatment for fractures of the femur, our initial experience in this type of intramedullary nailing form the basis of this report. METHOD: This is a retrospective study of all cases of fractured femur that were treated with locked intramedullary nailing between March 2002 and September 2003. RESULTS: During a 19-month period, 19 patients with 19 fractures were treated for fracture of the femoral shaft with locked intramedullary nailing using the Russell-Taylor (18 fractures) and Grosse-Kempf (1 fracture) nails. Thirteen fractures (68.5%) had comminution of the Winquist-Hansen type III and IV 12 of which were statically locked. There were three intra-operative technical problems including the case of a subtrochanteric fracture, where the nail missed the medullary canal of the proximal segment. There were 2 cases of superficial wound infection, which responded to local wound care and antibiotics. Although limb length discrepancy and rotational mal-alignment were not assessed routinely during the follow-up of patients, no symptomatic malrotation was recorded. Sixteen out of the 19 patients were available for follow-up for an average period of 11 months. All these cases progressed to union, without the need for dynamization in statically locked fixations. CONCLUSION: In spite of the initial problems encountered with this relatively new procedure in our centre, we were able to achieve a reasonably good result in addition to supporting the notion that dynamization of a statically locked nail is not always necessary for healing of fractures.

Efficacy and safety of enoxaparin, a low molecular weight heparin in the prevention of deep vein thrombosis in Nigerian patients after orthopaedic surgery.

The objective was to determine the efficacy and safety of Enoxaparin as an antithrombotic agent in orthopaedic patients at risk for thromboembolism. 49 patients who had lower limb orthopaedic surgery were studied. They received subcutaneous Enoxaparin 40mg 12 hours before surgery and subsequently, daily for one week. Blood specimens were drawn at 2 and 12 hours after the first injection, and 24 hours after the fourth injection for anti Factor Xa assay. Specimens were also taken preoperatively, 1st, 5th and 7th post operative days (POD) for determination of Packed Cell Volume (PCV), Haemoglobin level, White Blood Cell (WBC) and Platelet Counts. The mean pre-treatment, 2, 12 and 24 hours anti Factor Xa clotting times were 14.5 +/- 0.8, 36.2 +/- 5.6, 30.6 +/- 9.8 and 25.8 +/- 9.3 seconds respectively. The changes were significant, P = 8.2 x 10(-12). The 2 and 24 hours clotting times corresponded to plasma heparin concentration level of 0.12 - 0.22U/ml read off from prepared Enoxaparin standardisation curve. Significant changes were observed in haemoglobin level, PCV, WBC and Platelet Counts when preoperative, 1st, 5th and 7th POD mean values were compared by Analysis of Variance--P < 0.01 in all cases. The study showed that Enoxaparin 40 mg daily caused hypocoagulation within prophylactic range of 0.12 - 0.22U/ml of heparin in the plasma. Changes in blood counts were within the limits expected post surgery.